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Guest blog - Krissie Stiles

At Red Square Medical, we love a bit of social media, especially LinkedIn, and we literally fell in love with this month’s guest blogger, Krissie Stiles, for the power of her LinkedIn posts. Krissie’s personality and passion for her work just fly off the screen and grab the attention. So we’re delighted to introduce the amazing Krissie to our followers and let you all enjoy and learn from a very special guest blogger!

Hi everyone, I’m Krissie and I’ve spent the last few years working as the Plastic Surgery Clinical Nurse Specialist (CNS), caring for patients with soft tissue and orthopaedic trauma.


I’m 44 and have lived in the UK since I was 15 years old. I was actually born in Riga, Latvia and am a child of the Soviet era.


I started my career studying adult nursing at the University of Brighton where a burn specialist nurse’s lecture in the 2nd year drew my attention to the burns speciality. I was fascinated by the impact of burns trauma on a human body and the incredible reconstructive techniques available to recover soft tissue. The dressing techniques required to care for these injuries, and the amazing burns multidisciplinary team that supports burn survivors for the rest of their lives. 


I knew straight away that I wanted to be part of this world. I requested a burns unit as my Elective and Management placements towards the end of my training, and once qualified in 2003, I was invited to stay on as burns unit staff nurse at the world-renowned Queen Victoria Hospital – the home of the Guinea Pig Club and the RAF pilots who received pioneering reconstructive surgery at the hands of Sir Archibald McIndoe in WW2. 

The set up on the burns unit was such that a staff nurse could rotate and work across all of the aspects of burns unit care – from the burns ward, operating theatre, burns outreach, critical care and outpatients, which were all integrated in a single burns unit. With a desire to progress, I passed the British Burn Association’s Emergency Management of Severe Burns course and achieved a Diploma in Professional Clinical Practice: Burns, Plastic and Maxillofacial Reconstruction Pathway.


Later, as my clinical work shifted towards the burns ICU, I completed BSc in Acute Clinical Practice and in 2019 I graduated with an MSc in Burn Care from Queen Mary University of London (QMUL). My dissertation followed my interest and passion in out of hospital care, titled ‘Preventing hypothermia: defining standards for the UK pre-hospital burn care and transfer’. I passed with a Distinction and was invited back to the QMUK PGCert/MSc Burn Care programme as an Honorary Lecturer.


It might sound strange, but burn blister deroofing is my favourite procedure. It’s exactly what it says and is what we do to remove the blister so that we can fully assess the wound and promote healing. I know it may seem gruesome, but I love doing it – there is something really satisfying about having a pristine and clean wound bed.

In 2011, I was offered the post of the Burn Care Advisor – an innovative post across the London and South East of England Burn Network (LSEBN), which devoted a burn specialist nurse to work outside of the burns unit. The aim was to improve pre-burn centre care of burn survivors and supporting education of the pre-hospital and ED clinicians who cared for our patients first. 


This was a fantastic opportunity to build relationships with our referring clinicians and  improve understanding of each other’s resources, challenges and limitations in the emergency care of burn injured casualties. I worked closely with Fire and Rescue Services (FRS), road and air Ambulance Services, Emergency Departments and GP practices across three counties, which formed the catchment area for referrals into our specialist hospital. It was the most eye opening and most productive and fun role I have ever done! I learned to teach my subject in a way that is relatable and practical for those with resources way more limited than mine.


I took part in prehospital clinical governance days where burns scenarios were played out in real time. This made me realise the importance of key interventions delivered well, and the  importance of practical guidance tailored to the capacity and resources of the first responders. I designed and delivered Burns Management Study Days for clinicians outside of the burn speciality who wanted to improve their understanding and skills in burn care – whether in pre-hospital, trauma or community settings. I also got to ride on a big red truck, fly in an air ambulance on an observer shift and organised an iconic photo shoot for the National Burns Awareness Day with FRS, road and air Ambulance Service, and our burns unit team. I could go on… the highlights are just too many to mention!


Soon after, I also added the LSEBN Lead Nurse title to my name – a post that enabled me to lead on development of regional burns referral and initial management clinical practice guidelines (CPG), which are used to this day. A while later I joined the British Burn Association (BBA) as a nurse member of the Executive Committee, which saw me pioneer the first ever BBA Pre-Hospital Special Interest Group and progressed the previously developed regional CPG’s to be accepted at a national level. 


In 2017, I took on a Trauma Outreach CNS post, which took me into patients’ homes and into tertiary hospitals to help non-specialist clinicians assess and treat soft tissue trauma. 

After a year in the role, I was given an opportunity of a lifetime when I was invited to join The Katie Piper Foundation as the Head of Clinical Services. This role tasked me with setting up the first ever UK-based residential rehabilitation centre for burn survivors and allowed me a privileged insight into the long-term impact of burns. It reaffirmed to me the life changing effects of early interventions on burn survivors’ long-term quality of life and the role I have in advocating and sharing this knowledge to the healthcare professionals who hold an incredible power in their first responder hands. 


I wanted an opportunity to work at a Major Trauma Centre and when one came up within the plastics trauma field – I couldn’t turn it down. I was keen to continue to develop my role as an autonomous practitioner, but I didn’t want to lose my place as a bedside nurse. The CNS role is a perfect combination of autonomy and clinical expertise, an opportunity to see trauma patients from admission to healing. 


I started my current post in January 2020, returning myself to patients' bedsides at one of London’s Major Trauma Centres, just before the COVID pandemic stopped the world. After a redeployment to COVID ICU within months’ of starting in my new role, I eventually re-commenced my clinical practice of caring for survivors of trauma. 


My patients are survivors of trauma. Their injuries may be due to a fall, road traffic collision, assault, suicide attempt, or an animal bite, resulting in full thickness soft tissue loss. 


On a typical day, I would  join the plastic surgery team, visiting patients who are either awaiting or have already undergone reconstructive surgery across the hospital’s wards. Each visit is different – sometimes the purpose is wound assessment or a dressing change, sometimes it is a preliminary chat to explain what surgery may be required and how it will be carried out, sometimes it is to offer aftercare advice and education to the patients about to go home. I also frequently saw returning patients in the outpatients’ clinic for wound reviews. 


Teaching is a large part of the role – training and supporting the recovery, ward and clinic nurses, who are tasked with caring for patients who have undergone reconstructive surgery. I also educated adult and paediatric ED teams on initial care of burn injured patients. You’d also maybe see me sneak in to support the Emergency Department Resus team with care of the major burns admissions - in the initial assessment, management and onward referral to the specialist burn service. 

I was a lone CNS working with 4 Plastic Surgery Consultants and it wasn’t until I became an autonomous practitioner that I realised what a blessing it is to have a large team around you – someone to check in with you, someone to notice when you’re flagging and in need of a cuppa, someone who can celebrate the days’ successes with you and someone who ‘gets it’ when it comes to the type of traumatising and yet rewarding work we do. On the other hand, being with patients was my favourite part of the job. 

I love getting to know the humans behind the injuries, the bandages and the trauma. Our patients tend to stay with us for a while, making this possible. And the nice thing is that when they return to the clinic for follow-up and continue to come back for many weeks or months, it feels more like a family reunion rather than a job. There’s nothing more satisfying than achieving healing for patients and knowing they can now get on with the rest of their lives. 


My second best part of the job  is teaching. I have students who, years later, tell me how memorable and impactful my training sessions were. I have had applause, had the audience in tears, had clinicians queuing up after my talk either wanting to tell me of their own personal experience with a burn injury or one they’ve been challenged by in their clinical practice. No one forgets their encounter with burns quickly – they are rare, but when they do happen, they stick with you. (The Red Square Medical team can vouch for this fact too!)


Luckily in my role, emergencies are rare as we tend to enter the process once the patient is in hospital. But one of the main surgeries our plastic surgery team performs to salvage limbs with massive soft tissue trauma, is microvascular free tissue transfer – a flap, for short. Flap is dependent on adequate arterial and venous blood flow and a lot of post operative nursing care is to monitor for any signs of tissue compromise. Any sign of deterioration will require an urgent return to the operating theatre to save the flap, and more importantly, the patient's limb. In this case, nursing observations are essential to the timely identification of any concerns. 


When it comes to patients with burns, compartment syndrome is probably the most time critical for limb or digit salvage. When the burns are deep and circumferential, these can impair chest expansion and breathing or compromise viability of a limb or a digit, unless emergency decompression (called escharotomy) is performed. The bedside clinician needs to be attuned to the risks of deep and circumferential burns and monitor for signs of patient deterioration and neurovascular complications. The escharotomy procedure is usually performed in an operating theatre. It is very bloody and can appear almost barbaric, but it releases the constricting tight flesh, and re-establishes blood flow to the struggling tissues. 

Before I was known as ‘Krissie Plastics’, I was for a long time ‘Krissie Burns’ and I’ve already mentioned my journeys in burn care. My legacy (if I ever have one) would be to improve the sharing of specialist knowledge with those clinicians (such as Paramedics, and other pre-hospital medics) who work outside of the specialist services, and who often care for our patients first.


If we are to truly aspire to improve the quality of outcome for our patients, then we have to embrace the fact that those first responders on scene – the Fire and Rescue Service, Ambulance Service and Emergency Departments - are our extended burns team, with capacity to influence our patients’ long-term quality of life outcomes with their early interventions. In a maritime context, this also includes YOU!


It may seem strange that my work in burn care has actually taken me outside of the burns unit, but this is exactly where I feel we can reap some of the largest gains for our patients. 


My interactions and work with the Fire and Rescue and Ambulance Services have resulted in some immensely impactful and potentially life-altering practice changes. These were simple changes that followed the latest evidence and were capable of positively influencing the outcome trajectory of individuals affected by burns. 


Around this time, a Paramedic colleague of mine reflected on the changes that have been implemented with my support and jested: ‘Krissie said. We did’!. Since then, ‘Krissie said’ became a thing! So much so that I have since been described as ‘the Google of burns care’ and in fact my Twitter handle is quite idyllically @krissiesaid as a nod to my professional history in burns.


I am lucky to work in a fast-evolving speciality, where the surgical team are very hands-on with wound care, which allows me to access mentorship and supervision at the bedside. I attend burns, pre-hospital and wound care conferences, and follow the latest developments in practice through reading journal publications, attending webinars and listening to podcasts on the subjects that interest me and those useful to my clinical practice. The most recent training I attended was in sharp debridement – a fantastic tool to have as an autonomous wound care practitioner. 

It’s fascinating to take a look at the world in which Red Square Medical operates and my key advice for anyone going out to sea is… sunscreen! High factor, and I mean 50+ SPF, suncream generously applied. Radiation (sunburn) burns are unpleasant at best and incredibly debilitating at worst - so prevention is key. 


We all should have SPF in our daily skin care routine, as sun damage doesn’t only pose a risk of burns, it actually ages our skin quicker and can lead to skin cancer. As the recent Melanoma UK campaign says: ‘Be good to your skin – you’ll wear it every day for the rest of your life’. 


While burn prevention is the ideal, burn injuries are still relatively common at sea and can range from minor to the most severe burns. 

Severe burns can be life-threatening in themselves, but can also obscure other time-critical injuries, so their assessment must follow the ATLS trauma protocol. Patients will require an emergency evacuation to a land-based hospital for initial assessment and stabilisation, from where the patient will require onward transfer to a specialist burn centre. 

Minor burns are likely to be more common onboard and will require what we call a FACADE approach to initial care, especially if you’re looking to keep the patient onboard. 


FACADE stands for First Aid, Analgesia, Clean, Assess, Dress and Elevate. 


F - First Aid with cool running water for 20 minutes within 3 hours of the burn.

A - Analgesia - we need to proactively manage their pain.

C - Clean and deroof all blisters (see later note!).

A - Assess the depth and size of the burn.

D - Dress with clingfilm (for transfer) or non-adherent absorbent dressing (for local treatment).

E - Elevate limbs to reduce oedema.

My key pieces of advice for any crew and onboard medic would be:


  1. Ensure you have a ‘water strategy’. Have a Plan A,  for when you have 20 minutes worth of water (great – this is the gold standard!). But when you only have a limited water supply using alternating wet compresses over a 20 minute period is the next best thing. If you don’t have access to running water, consider sea water as an alternative cooling solution. Of course there is a risk of infection, but that can be dealt with later on, cooling is the immediate priority.

  2. However, always be mindful of hypothermia when cooling, as this can negatively affect your patient’s condition and long-term outcome. Cool the burn only but keep the rest of your patient wrapped up and warm, even if you’re in a warm or hot climate. If you notice any signs of hypothermia – stop the cooling and actively warm your patient.

  3. Have really good analgesia onboard if you are able. Burns hurt. Like – a lot! And if you are looking to treat your patients on board, and especially if you are attempting the ‘C’ element of FAÇADE – your patient will appreciate some decent pain relief before the procedure and at regular intervals afterwards, as their burn wounds are healing.

  4. If you are unable to deroof burn blisters due to confidence, skills set and/or resources – you will not be able to assess the severity and the extent of your patient’s burn wounds. This is an essential burn wound care step, which will not only allow accurate assessment, but will also reduce the risk of infection for your patient (by removing non-viable tissue). Depending on the situation, your Telemed Doctor may advise and guide you through this process.

  5. If a burn wound has been deroofed, it will be painful, leak a lot, and require frequent (often daily) dressing changes. Make sure you have wound care products that will not stick, will absorb wound exudate (the gooey, sticky stuff), prevent infection, and allow movement.

  6. Reducing oedema and maintaining movement are key to expediting burn wound healing. This is especially significant for upper limbs, which have a huge functional component to our quality of life. Elevation is a passive way of reducing the impact of oedema and can be helpful when patients are resting. Make sure your patients are instructed that movement is necessary while they are healing. If you wait until the wounds are fully healed, your patients will have incredibly stiff and immovable joints, and it will take weeks of therapy to regain function once again. Avoid this by getting your patient to move as soon as you’ve applied your first dressing! And ensure you bandage in a way that will not restrict movement.

  7. Always seek advice from a burn specialist for any burns that are deep or affect significant areas like face, hands, feet, and genitals, as these can have lifelong complications for your patients, however small and insignificant these may seem to your clinical eye. In the very least, advise patients to have follow up with a burn service once you dock. 


Facial burns are an interesting thing, and we rarely dress them. Instead we apply soft yellow paraffin (Vaseline) to reduce the discomfort of air against the open wound bed. Faces heal really well when kept clean and Vaseline’d. They also tend to look really bad as they heal – oozy, scabby, crusty, before they look absolutely awesome. The trick is in the regular washing with soap and water as tolerated, and lots and lots of Vaseline, especially on lips (they tend to be the sorest). And obviously, tell patients to stay away from naked flames and no smoking when wearing all that flammable grease on their skin! Oh, and make sure to tell them to sleep propped up on lots of pillows as this will really help with facial swelling and may prevent the momentary panic when waking in the morning and being unable to open severely swollen eyes!


Of course, some of the things I’ve seen and experienced over the years have been traumatic and I am an emotional person, so mental fitness is a fine balance for me. In the first instance, debriefing with my colleagues is instrumental – it is validation of my experience and my feelings by people who’ve been there too.


I also have a great support at home, and this is a safety blanket that I come home to, it nourishes me and restores me when I need it. I love to work out - I exercise to feel physical achievement through discomfort, to elevate my mood and attitude, and sometimes I exercise to exorcise. Fitness has been my best and my most consistent ‘therapy’ over decades.


Finally, I met my husband, David Wales, at an international burn conference where he was a single Firefighter amongst hundreds of burns professionals, presenting on his research of human behaviour in fires. I approached him as a keen, newly appointed Burn Care Advisor to discuss care on scene and to find out exactly why the Fire and Rescue Service don’t ever use the huge tank of water, they carry on their appliances, to deliver essential first aid to burn injured casualties!


This struck a chord with him and led to years of collaborative working, culminating in publication of an award-winning ‘Saving Lives is Not Enough’ report on the  importance of the role of FRS in burn survivors’ long-term outcomes. Ten years after meeting and working together, a firefighter and a burns nurse became husband and wife!


To find out more about Krissie’s incredible work and keep up to date with the latest in burns information, you can follow Krissie on LinkedIn here: https://www.linkedin.com/in/kristina-stiles-msc

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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.

Safety of Lives at Sea

by Rachel Smith • 17 June 2024
Working at sea can be one of the most rewarding and fulfilling careers. But you can’t gloss over the fact that it can be dangerous. Whether you’re working on a tanker, ploughing up and down the oceans, a Superyacht enjoying a busy season of charters, or any vessel in between; our love/hate relationship buddy Neptune takes no prisoners! The Safety of Lives at Sea (SOLAS) Convention in its successive forms is generally regarded as the most important of all international treaties concerning the safety of merchant and other vessels. The first version was adopted in 1914, in response to the Titanic disaster, and went through several iterations up to 1974. The Convention in force today is generally referred to as SOLAS 1974, as amended. SOLAS regulations cover all areas of safety at sea, including construction, fire prevention and detection, life saving equipment, cargo carriage, navigation, communications and a host of other areas. Regulation 33 of the SOLAS Convention applies to all ships, and places an obligation on Masters to respond to distress calls at sea and proceed ‘with all speed’ to their assistance. Anyone working in the maritime sector, hopes that they are never on the receiving end of this regulation, but we’ve experienced two quite different instances, where the ships we work with have responded and our Medical teams have played an important part in rendering aid.

Telemedicine - access to a healthcare professional

by Rachel Smith • 29 May 2024
This week’s blog is an introduction to telemedicine as although it’s probably been around for longer than you think, you might not be familiar with what’s available to help you. So whether you’re a leisure sailor taking on the ARC; work in commercial shipping, spend your time on a Superyacht, or anything in between, read on for more information… According to the UKs National Institute for Clinical Excellence, (NICE: https://www.nice.org.uk/), ships being on the water for months at a time mean that health can be a life-threatening challenge for sailors and seafarers. Access to healthcare providers has always been one of the most critical issues for offshore crews and it’s worth remembering that the International Labour Organization (ILO), dictates that access to medical treatments and health services should be guaranteed to seafarers in the same way as for people working ashore. Nowadays, telemedicine technology has emerged to improve healthcare delivery in many remote areas where there is no direct access to healthcare services using telecommunication services. Among them, maritime Telemedical Assistance Services (TMAS) have become more readily available and are now considered an integral part of a shipowner's emergency response operations. The advent and uptake of Starlink in both the commercial and leisure sectors can only be a positive from a medical perspective. So, what is Telemedicine? What does it do and how does it work? Telemedicine is a term that’s becoming more and more common in the maritime world. Quite simply, it is the provision of remote clinical services, via real-time two-way communication between the onboard medic (trained crew or healthcare professionals) and/or the patient themselves, and a shore-based healthcare professional, using electronic audio and visual means. The modern history of Telemedicine can be traced back as far as 1905, when a Dutch physician used long distance transfer of ECGs (electrocardiograms) to be read remotely. But as early as the 1920s onwards, radio communications were being used to pass medical information to patients at sea on ships and on remote islands. More recently, the COVID-19 pandemic has brought Telemedicine to the forefront of healthcare. Though we may not easily recognise what it actually is, the majority of GPs (certainly in the UK) and other allied healthcare professionals in the non-acute world, such as Physiotherapists and Mental Health support, have relied heavily on telephone and video consultations since March 2020. A survey conducted by Nautilus International and Martek Marine (2017) showed that a staggering 98% of seafarers believed that greater access to Telemedicine support would save lives at sea. Of those questioned, 68% had been on a vessel that was forced to divert due to a medical emergency and 70% had been on a vessel where there had been a medical evacuation. Emergencies experienced at sea ranged from severed limbs and broken bones, to gunshot wounds, tropical diseases, allergic reactions and sudden cardiac arrest. Whether you’re a commercial seafarer or leisure sailor, it would improve confidence in making a decision on whether an injury, or illness was severe enough to warrant a diversion, or evacuation, if there was a trained medic on the end of the phone or radio. Ever improving communications also means that we can now go far beyond voice calls. Photos of injuries, files of test results and even live streaming is all possible and helps to provide a much more indepth service. Our own team member, Rachel, received Telemedicine support via SatPhone and email, on a 7 metre Ocean Rowing Boat (yes, you did read that right!) in the middle of the Atlantic, when her rowing partner developed a painful injury. Remote intervention from a Doctor onshore helped to maximise use of the medical kit contents for the short and long term, rule out immediate worries of infection, and develop a pain management plan for the rest of the rowing race. One in five commercial ships a year are forced to divert for a medical emergency, with unknown numbers of other, non-commercial vessels on top. So there is also consideration for the cost and time involved, plus the stress to both the patient, and their medic who is managing a situation onboard, possibly alone!

Guest blog: Jordan Lin

by Rachel Smith • 8 May 2024
At Red Square Medical, we’re keen to support those who have a passion for maritime medicine. While we can’t provide placements for everyone, occasionally a request pops up at just the right time and we can provide some experience and insight into our unique and specialised world. Last year we were contacted by Jordan Lin, a medical student with a love of the ocean. This is his story… When I was a boy, my dad and I used to go fishing with a local fisherman off the Norfolk coast. I absolutely loved being on the sea and so for quite a long time, I wanted to be a fisherman. When I got a bit older I kind of forgot about this and think I may have been slightly put off by watching the TV series ‘World’s Deadliest Catch’! But I have always loved being on the water and spent a lot of time sailing dinghies; I was also a swimming teacher for children back in high school and college. Later, I decided to study medicine and I’m now a final year medical student at the University of Bristol where I completed an intercalated degree; a Masters in Health Sciences Research. I’m now looking forward to starting work as a qualified Doctor in August. Though having spent 6 years training, my next 2 years will be spent working for the required two foundation training years that must be completed before being able to work independently as a Doctor in the UK. At university, I joined the VITA network which is a group dedicated to developing a health and public health approach at the heart of any response to human trafficking and exploitation. I became the blog coordinator for the organisation and you can read the blogs, including those that I have written, here: https://vita-network.com/blog/ In my spare time, I have been involved with the Bristol University Hot Air Ballooning Society and trained through the society to get my Balloon pilots licence. So, I often spend weekends during the summer flying in a leisurely fashion over Bristol and the surrounding area!
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