MSN 1905 - 1 year on - Equipment!

Last week, we took a look at the ‘new’ drugs listed on the M1905 in March 2021. Shipping companies were given until March 2022 to update their medical kits onboard, so this week, we’re taking a look at the equipment introduced 12 months ago, as a quick reminder of what the equipment is, and when and how it’s used. 

As with anything, skill fade is a very real risk and we know that if you’re not using kit and equipment regularly, it’s easy to forget. Plus if you’re yet to complete a refresher, you might not be familiar with the updated equipment. Hopefully, this quick guide will help.

We’ve also listed the pages in your Ship Captain’s Medical Guide where you can find out more…

Pulse Oximiter (p202, listed in the index under airways)


A pulse oximeter is that handy little gadget that pops on to a patient's finger (or toe, or earlobe) and tells what the oxygen level or oxygen saturation (sats) are in the body. It’s non-invasive and can detect even small changes. 


It’s part of your examination and monitoring equipment and works by shining an infrared light through the finger to show how effectively blood is carrying oxygen to the extremities as well as giving you a pulse rate. If enough oxygen is getting to the fingers and toes, then the patient should have enough making its way to the brain and organs too, but if not, it provides a guide for oxygen therapy along with your shoreside medical support. 


For someone who is healthy, oxygen saturation should read around 92-98%. Don’t worry if it’s 99-100% though. Some people with lung (such as COPD) and heart conditions may have normal oxygen levels of 88-92%. They're unlikely to be working as crew on a ship, but could very easily be passengers. 


Of course a pulse oximeter does have limitations and you need to check the batteries regularly. It may not work effectively on cold peripheries or in the case of carbon monoxide poisoning, can pick up an inaccurate pulse in patients with atrial fibrillation (AF), can be affected by light and low blood pressure. It may not work on patients with painted or false finger nails but that’s easily resolved by turning it 90 degrees round the finger, or using a toe or earlobe. 

Blood Glucometer (p37)


A blood glucometer is used for testing the level of glucose (sugar) in the blood and is part of your examination and monitoring equipment.


It is invasive as it requires a small pin prick to break the skin, so there is a minor risk of infection. But, they are incredibly easy to use and can be invaluable in helping to work out what’s happening and whether it can be easily fixed, or required other intervention.


To test the blood glucose (sugar), first assemble the kit - the glucometer, testing strips, lancets and make sure you dispose of the sharp correctly afterwards.


Clean the finger and use the lancet to create a drop of blood. A tip from our tame Paramedic is to prick the side of the finger tip, slightly off centre, where it’s not quite so sensitive. Your patient will be grateful! 


Squeeze the finger until there is a drop of blood and then dip the testing strip into the blood. You’ll have to wait a few seconds for the result to display on the meter. 


Normal blood sugar readings will be between 4-6 mmol/l. If it drops below 4 or above 20, urgent treatment may be required under the guidance of your shoreside medical support. Taking a blood sugar reading is also a good way to rule out a potential cause of symptoms such as reduced consciousness, stroke symptoms, new confusion and diarrhoea/vomiting. 

Naso-pharangeal Airway - NPA (p200)


NPAs are an optional part of your resuscitation kit and both the 6mm and 7mm diameter NPAs are recommended. It’s simply a small tube with a wider section at one end, the flange. It can be used alone or with an oro-pharangeal airway and can be really useful if the casualty is suffering from ‘trismus’, where the teeth clench and it’s impossible to use an oro-pharangeal airway.


The right length/size is measured by holding one end at the side of the nostril; the other end should reach the ear lobe. Interestingly, the right nostril is normally slightly bigger than the left so most medics start there but either side will do just fine.


Lubricate the outside of the tube and insert it straight towards the back of the head, at a right angle to the face, not up towards the brain. Once inserted the flange will lie against the nostril.


The only caution is on the extremely rare occasion that a basal skull fracture is identified (by a wound, bruising around the eyes, bruising behind the ears, clear fluid coming from the nose), an NPA should not be used. 

Intravenous Access (p224-225 and p227)


Giving fluid and/or drugs through an intravenous (IV) route using a cannula is potentially a lifesaving technique, but must only be undertaken by trained personnel under shoreside medical team guidance. 


IV access means that the drugs or fluid can be introduced directly into the circulatory system and can work much more quickly and more effectively than oral medications. But, while inserting a cannula into a vein isn’t complicated, it needs training and regular practice to avoid skill fade. 


The cannula is a needle inside a fine plastic tube. The needle pierces the vein and the plastic tube advanced (or slid) over the needle to sit inside the vein. Then the needle is removed and disposed of and the cannula secured in place. 


Cannulas can be inserted into the back of the hand, the wrist or the inside of the elbow. This is an invasive procedure and comes with risks of infection and embolism from air or blood clots.

Intraosseous Access (p226-227)


As with the IV route, giving fluid and/or drugs through an intraosseous (IO) route is potentially a lifesaving technique, but must only be undertaken by trained personnel under shoreside medical team guidance. 


IO access sounds a bit gruesome as you are effectively drilling directly into someone’s bones to get to the marrow. But it is a fabulous way to get drugs or fluid into the circulatory system if you can’t gain IV access for some reason. 


It can work much more quickly and more effectively than oral medications and there are both manual and specialist options for firing or drilling the needle through the bone, normally in a site on the tibia that’s quite easy to locate.


IO is very similar to a cannula where a needle is used to introduce a plastic tube into the bone marrow.  The drill pierces the bone and is then removed, leaving the cannula tube in place to be secured. 


We also have it on good authority that practicing on a raw egg is ideal (as long as you don’t press too hard). It gives a really good ‘feel’ of pressing the needle against the bone, then the ‘give’ as it drills through into the marrow.


Of course there is a risk of infection and IO and while you can use IO on a conscious patient, it can be very painful, so steps would need to be taken to manage any pain. 


If you’re not of a sensitive nature, you may like to watch this US Marines film of an IO insertion but we warned… it’s not for the faint hearted! We recommend withdrawing a little of the marrow before flushing as it can reduce the pain dramatically be creating a space within the marrow first. https://www.youtube.com/watch?v=MgQJIsavbjI

Naso-gastric Tube (p13, 38, 65, 70, 148, 216, 220)


A naso-gastric tube is another advanced technique that should only be carried out under guidance from your shoreside medical team. 


It’s used to introduce fluid or food, or allow gas to escape from the stomach and can be used if your patient suffers from persistent vomiting, needs hydration and feeding but can’t swallow, has a distended or rigid abdomen or if they are unconscious - to deflate the stomach and reduce the risk of vomiting and aspiration (vomit getting into the lungs). But inserting and NG tube comes with a reasonable risk of the tube accidentally passing into the lungs instead of the stomach. This could have catastrophic results if not identified. 


The good news is that there are plenty of ways to check that the tube is in the right place (p216) and your shoreside medical team would be able to help you make totally sure it’s in the right place. 

We hope you’ve found our M1905 refreshers useful, and if you’d like any further information about the updates please get in touch.



Note: For the purpose of this blog, all measurements and techniques are in line with the 23rd Edition of the Ship Captain’s Medical Guide, but may vary slightly in other publications.

Chest pain

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:

FleetMed Support - Launch

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.

Vaccinations - A useful overview for seafarers

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.

Red Square Medical – End of Year Review

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.

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.
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