Guest Blog - Rachel Smith

I was born in a tiny village in Northamptonshire but had a fairly nomadic childhood, eventually settling in the industrial town of St Helens in the north west. As a child I was horse mad, so boats never got a look in. Apparently ‘horse’ was the first word I said and despite the fact that we could never afford a horse, my dream was always to ride and work with horses. 

It’s perhaps an early indication of my goal-oriented side that I got a Saturday job as soon as I could. At the age of 13, I’d cycle a 12 mile round trip, twice a day, just to go and ‘muck out’ at a local farm where they bred Welsh ponies and Arab horses! There wasn’t even any riding.

Later, I found myself working for the family of a young girl who would go on to represent Great Britain in dressage at the Olympics. The work was physically hard and the standards high. No corners were cut and I learnt the skills I needed the old fashioned way. I got to travel all over the UK in the branded horsebox which was pretty exciting for a teenager. But I think I will always be grateful for the solid work ethic and sense of responsibility that this job instilled in me.

I always planned to leave school at 16 and go to ride racehorses. But I got quite reasonable exam results and a new degree course was announced in Equine Science and Business which changed the plan. So, after taking the required year out, when I worked in an eventing yard in Yorkshire, I started the 3 year course. For the two work placements, I opted to go abroad, to Italy and the USA, which supercharged my desire to travel.

I continued working in the equestrian world for a couple more years, but the poor pay and prospects, plus a dose of pneumonia pushed me onto a different path. I got a job in telemarketing for a bank, and after putting forward the idea of finance for horses, I found myself transferred to Marketing for 6 months. 16 years later, I was still there!

So, where do boats and maritime fit into this? Being quite outdoorsy, my first boat trips were holidays on the Norfolk Broads. I took up canoeing and kayaking in 6th Form, and this led to a 25 year career in Dragon Boat Racing where I represented Great Britain multiple times and won 25 World and European medals, plus 2 world records.


In the meantime, the bank I worked for had Marine and Shipping divisions and when I took over the marketing for them, there seemed to be a natural fit and I could understand and really get under the skin of the slightly fickle marine finance marketplace. Consequently, I looked after the business area for 12 years until I left.

Being ‘in the business’ proved quite handy too, after entering the Atlantic Rowing Race 2007 with my best friend. Together we rowed 3,000 miles from La Gomera to Antigua in 76 days, 11 hours and 12 minutes, in our 24 foot rowing boat, Barbara Ivy. We raised over £65,000 for Breast Cancer Care and hold 2 Guinness World Records. 


Life changed after the row. The credit crunch happened while we were at sea, so the job I came back to was very different to the one I left. I was eventually allowed to take voluntary redundancy in 2009 and headed off to work a 12 month contract at the UK Hydrographic Office for the MoD. I then had a few years of trying to decide what I wanted to do next and after a few contracts, I was asked to join a small team to create a $70 million start up company. But, I’d already decided that I wanted to become a Paramedic, so I took the job knowing that I wouldn’t be staying for too long. I also joined Cheshire Search and Rescue team in 2010 and have been a member ever since. 

My first sailing experience was a 330 mile delivery trip the summer after the row. Downsides: it was freezing and some of the time I wasn’t sure I was enjoying it. Upsides: I got to sleep for 4 hours at a time rather than 2, and on the last night, a solo stint on the helm, with the sun setting, convinced me that I wanted to do more. One of our sponsors for the row had offered to take us through our Day Skipper qualification so I took them up and went on to complete my Coastal Skipper and Powerboat Instructor too.


I spent 8 years working frontline for the Ambulance Service, right through the pandemic, and I left a year ago. I don’t regret it for a minute - though the more than 50% pay cut at first was a shock to the system. I learnt a huge amount about myself and humans in that time. I saw people at the best and worst times of their lives. I’ve delivered babies, been to fatal RTCs, fought to save lives, been a social worker and problem solver, talked someone down from a bridge, met war heroes, dealt with fear and grief, been punched in the face, experienced some weird and wonderful situations (often very funny!) and always tried to do the very best for every patient. I loved it. But it burnt me out and I decided that I wanted to make a change.

One of my previous managers always said, ‘if you don’t like it, you know where the door is’. I actually take this to be a positive statement - if you don’t like your current situation, then only you have the power to change it. 


So, I put it out to the universe that I’d love a job that involved Marketing, Medicine and Marine. But those jobs don’t exist. I did contact a couple of well known companies, but we were in lockdown and no one even replied.


A chance conversation during lockdown led to me being introduced to Liz and Red Square Medical. I did some teaching, wrote a mini marketing plan… and it led to a 2 days a month retainer while I still worked full time frontline. But the marketing worked and 12 months ago, we were in a position for me to go part time with the NHS and work 2 days a week for Red Square Medical. This increases to 3 days a week in 2024.


But it wasn’t that simple and my Trust and I couldn’t agree on how the part time Ambulance work would look. Then an unexpected meeting with Outreach Rescue solved the problem and meant that I could leave the NHS altogether. Now when I’m not working with Red Square Medical, I’m generally found halfway up a mountain in Snowdonia, teaching first aid and medical training up to Paramedic level, and for a number of Search and Rescue organisations globally.


My job title for Red Square Medical is Medical Operations Manager and it happily combines my rather unusual skill set of Marketing, Medical and Marine! Who would have thought that my dream of 4 years ago would turn into reality!


Previously I’ve worked on and around a wide range of power and sail boats, and now I can include Superyachts, cruise and expedition ships on the list. 


A typical day will depend on where I am. I could be teaching for one of our clients - this year students have ranged from leisure sailors to solo ocean racers, chefs to captains and everyone in between. I carry out the medical audits for some of our clients, which involves being onboard for a few days, going through the medical facility from top to bottom and making sure the high standards are met and maintained.

If I’m working in the office, I generally start quite early to get to grips with emails, then I could be booking in courses and instructors, developing or reviewing courses, creating marketing content and writing blogs, interviewing guest bloggers, managing the regular reports that come in from the ships we look after, writing processes or policies, and managing the many client and supplier relationships that make it all happen. 


I truly love what I do, so it’s hard to pick on a least favourite part of the job. I guess it would be the stress caused if an instructor lets us down at the last minute and I have to start scavenging around to find someone suitable for. It’s incredibly hard to find reliable instructors that work at the level we require, and have relevant offshore experience. 


I love the fact that this is a job where all of my weird and wonderful skill set is used and challenged, and that I work for a company that appreciates me. I love taking a group of students through a course and seeing the difference in their confidence and skills from start to finish. I love seeing the results of the marketing and knowing that it’s working. And of course, I love my time onboard vessels out at sea.


My 2 days a week is variable and not always 2 full days, but may be split into a few hours over several days. I probably spend 75% of my time in the office and 25% with clients, though that changes month by month!


Having worked frontline means you really do get to see everything and Paramedics are a pretty unshockable bunch! Even on land people get themselves into all sorts of problems and being the smallest, inevitably it was me who had to crawl under the sink, into the car wreck, or climb through the window I’d just smashed open. In a frontline role you can experience anything from birth to death from one job to the next and you never know what’s coming. In my last shift on the road I went to a cardiac arrest, a child having a seizure, chest pain, critically low and unstable blood pressure, amongst other jobs. You literally have to be ready for any medical emergency at any time.


Playing midwife was my most feared job and I know I’m not alone. Paramedics have limited training in delivering babies and until the baby is out and you’re sure that baby and Mum are OK, it’s the worst job in the world. Of course once it’s born, breathing and healthy, it’s the best job in the world! 


Sometimes it’s not just the medical side of the job that gets you. Dealing with the aftermath of a suicide is tough. Dealing with end of life patients. Or taking someone to hospital and leaving their husband or wife of 60 years at home, knowing that’s probably their last goodbye. Or fighting to save someone and not being able to. That’s tough, but it's all part of the job. 


There are too many funny incidents to mention, and of course many were probably only funny at the time - Paramedics are known for their dark sense of humour! As Liz said in her guest blog, Morphine can act like a truth serum with hysterical results! Then there was the guy who cut the tube of his catheter and wondered why he couldn’t stop peeing! And the lady who had an alien spaceship over her house!  The list goes on…


For anyone interested in this line of work, being a Paramedic can be frustrating and rewarding in equal (sometimes unequal) measure. But now is a great time to be a Paramedic because the medical world is starting to understand the place of these strange creatures. There are still several routes into the job: a 3 year university degree, an ‘on the job’ training program offered by several Trusts, or completing modules with an organisation such as Outreach Rescue to gain an equivalent qualification and apply for registration. Relevant experience helps - so first aid, customer service, or care work can help you to stand out from the crowd, and a bit of life experience helps. 


Frontline work is where you earn your stripes and develop that fantastic foundation. Then, the world is your oyster as more and more jobs are opening up for Paramedics in primary care, hospitals, training, prisons, TV and film, mental health, offshore and cruise, expedition, remote and humanitarian. It’s a good time to be a Paramedic.


But be realistic. It’s not all blood, guts and trauma. Frontline, much of your time is spent dealing with the elderly (falls, UTIs, dementia) and mental health of varying severity. You may have to treat those who you have very different morals, ethics, politics and opinions to you, or those who come from backgrounds, races and religions that you don’t understand. You will go to thousands of calls that do not need an ambulance. It can be stressful, frustrating beyond belief, emotional, exhausting, and the shifts are brutal. But just occasionally there’s a great job, or a special patient, and you’ll remember them forever. You need to be curious and a people person.


But, you never know where it might take you! I had no idea 5 years ago that I would be sitting here, writing about how my dream of combining Marketing, Medical and Marine might just come true!

Teaching helps to keep me up to date as I always have to be a step ahead of my Paramedic and SAR students. I also do some event work to help keep my clinical skills current. This year I’ve completed ACLS, PALS and PHTLS instructor courses and completed a Difficult Airway course. I attended the WEM conference and have started to listen to podcasts.  I already have a list of courses to choose from for 2024 and I will be going out to Antigua to volunteer with the Search and Rescue team for a couple of weeks. 


By the time you read this, my hours with Red Square Medical will have increased and I hope to be working on implementing the amazing ideas that came from our strategy days last year. 


I do a variety of things to help stay sane (some may argue that point). Of course I love any watersports and we have a garage full of kayaks, a canoe, paddle boards and surfboards which we plan to use more. I enjoy a good walk, swimming and the gym, and going out for dinner with friends. I even did an oil painting workshop recently and found it totally absorbing!


My best advice to go to sea is to have a contingency for everything. Prepare, then prepare some more. Have back ups for your back ups. The ocean can be a formidable foe or the most fabulous friend. 


Finally, something you might not know about me is that I once went on Ready, Steady, Cook and won! Green Peppers rule!!!


Why not share this with someone that you know who is looking for a change in direction....loads of top tips!

by Rachel Smith 12 February 2025
In this month's blog, as aching hearts aren’t just related to Valentines Day, we’re taking a look at chest pain! Chest pain is a common reason for calls for an ambulance or to shoreside, and frequently it’s not actually due to cardiac (heart) issues. But you will often hear Paramedics tell their patients that they have done the right thing; they would genuinely prefer to get to a patient and find the chest pain is a minor issue, than it being cardiac, and too late! Last year, we wrote this blog about 20 causes of chest pain (plus a bonus one!). Some of the conditions described are acute (sudden onset), some are chronic (long term), some need urgent attention, others not so much. But we should always take chest pain seriously and make sure a full assessment is done at the earliest opportunity to rule out anything life threatening. Typical symptoms of cardiac chest pain and/or a heart attack are:
by Rachel Smith 29 January 2025
Get ready for something super exciting! After a full year of intense planning and meticulous preparation, we're thrilled to announce the launch of our all-encompassing medical support service — FleetMed Support! Customised Maritime Medical Solutions Whether you have a fleet of ships or a single vessel, managing medical operations can be daunting without dedicated support. This makes FleetMed Support a perfect solution for the cruise, expedition and superyacht sectors. Our approach is simple: We take the burden of medical management off your shoulders, allowing you to focus on the bigger picture. With 24/7 support, we create a customized service level agreement for your fleet, ensuring that every detail is taken care of. So what’s new and why haven’t we done this before? Well, we're not a company that rushes into things. Instead, we take the time to thoroughly research and understand what's needed, ensuring we can deliver to the very high standards we set for ourselves and maintain those standards at all costs. Let's be honest, it's the continuous pursuit of excellence, the commitment to always improve, and the understanding that there's always more to learn that drives us forward each day. This means we are now ready to launch what we believe is a truly great portfolio of customisable services. So, how could this look for your company? Working with us is straightforward and hassle-free. We start by listening carefully to your specific requirements so that we can thoroughly understand your needs, and discuss your current gaps. Once we have a clear picture, we craft a tailored plan to deliver the precise services you require. Our process is marked by clear and concise communication at every step. We believe in total transparency, ensuring that you are kept in the loop throughout the entire process. We pride ourselves on our efficiency and dedication. Once the plan is in place, our experienced team gets to work, executing the agreed-upon services with precision and care. Our goal is to deliver exceptional results without any drama, making your experience as smooth and stress-free as possible.
by Rachel Smith 15 January 2025
From Flu jabs to far flung destinations… Vaccinations are a hotly debated topic across the globe, particularly after COVID-19 and the rapid response to the need for a vaccination to help reduce the burden on the health services in different countries. While the majority of healthcare workers and the general population support the ‘prevention is better than cure’ line of thinking, and therefore vaccinations, there are others who are determinedly against vaccinations for any disease, whatever the risk of mortality and death may be. In the UK, the BCG (Bacillus Calmette-Guerin) vaccination used to be given to all children in their teenage years to protect against tuberculosis. The vaccine has been so successful that TB is virtually eradicated now, and the majority of cases are due to migration. Now it’s only given to those deemed at high risk - babies and children at high risk, those travelling to high risk regions and adults coming into the UK from high risk countries. Depending on your country of origin, you should receive a range of vaccinations as a child or young adult. This will most likely include diphtheria, tetanus, polio and whooping cough, hepatitis and HIB (Influenza type B). Then MMR (measles, mumps and rubella), the pneumococcal vaccine (meningitis, pneumonia and sepsis) and HPV (Human Papilloma Virus) with a variety of boosters along the way. At the other end of the scale, the over 65s can receive vaccines for shingles, pneumococcal vaccine and respiratory syncytial virus along with flu and covid vaccines.
by Rachel Smith 30 December 2024
Reflection is an essential part of medicine and our regular followers will know that every year, we like to take a look back and assess where we started and how far we’ve come over the last 12 months. So, please join us on our whirlwind recap of 2024 as we get ready for a fabulous 2025… In 2024 we increased the number of STCW training clients to 4 organisations in 6 locations. We delivered STCW training at all levels to over 250 students. We delivered bespoke training to over 75 students onboard Superyachts and cruise ships. We delivered first aid at work or oxygen training to over 40 students, on land and on ships.
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.
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?
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
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!
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.
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.
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