ABSAR has an advanced Emergency Medical Technician working full time, plus a registered Nurse, and several EMTs and First Responders who are members.  All of the volunteer crew are trained in basic first aid and CPR. Any assessment and treatment is provided free of charge, but patients can make a donation of their choice in return, if they are able to.

ABSAR was started in 1998 by Julie Esty after two young sailors were lost at sea and the need for a formal Search and Rescue organisation became apparent to coordinate marine and aerial searches. Jonathan had already been providing support for the many sailing regattas based in Antigua and so the service developed.  It’s now extremely well equipped with the Medic Station, a response vehicle, ambulance, firefighting vehicle and two RIBs on the water. Plus access to aircraft when needed. 

The majority of the drugs stocked are supplied by visiting yacht crews, which means the selection is extensive and far greater than we would see in most UK emergency medical facilities. But the type of cases they attend to is also very varied. 

There is a hospital on the island and a number of specialist clinics for residents and visitors. Antigua does provide free healthcare and medical treatment for residents, however visitors to the island are expected to pay prior to any kind of assessment or treatment and this can run into hundreds of dollars for just an initial examination and thousands if follow up treatment is needed. 

Many local people in the South of the island (where ABSAR is based) do not have transport and this restricts their ability to get to the hospital. It may only be about 14 miles but the roads in Antigua are sometimes not much more than tracks, and apart from a couple of the main roads, they are generally in a poor state of repair. So travelling by road with any kind of injury can be extremely challenging. The ambulance service in Antigua is limited and under pressure from demand in the same way most ambulance services are. There is a bus service, but it’s quite random most days and doesn’t run to a schedule!

Often patients will have an initial assessment and treatment at the ABSAR Medic Station before being referred on to a doctor or the hospital. ABSAR is well known on the island, has a good relationship with local clinicians and regularly refers patients to the various doctors, depending on their area of expertise. 

Infection is a specific complication of wound care in the tropics, and it’s known locally as ‘Dockyard rot’. Even a really tiny open wound can develop a necrotising infection which needs regularly debriding and cleaning, plus treating with topical and/or oral antibiotics. Consequently all wounds are treated with Betadine solution in the first instance, and ABSAR monitors any wounds they have treated over the following days. 

Ear problems are common and I noticed a steady stream of patients requiring ears checking, syringing and one assessed for a burst eardrum after unsuccessful equalising when scuba diving. There were also a number of people who requested blood pressure checks which were provided.

For wound closure, sutures are generally preferred as glue doesn’t set so well in the high temperatures.

The following list shows an example of the variety of patients seen during my time with ABSAR. Any photos were taken with permission of the patient:

Fish hook in thumb – digital block with lidocaine, hook removed using a technique where a cannula is used to cover the barb before drawing the hook back. The other method is to push the barb all the way through. The wound was treated with Betadine, topical antibiotic and dressed. 

Fishing spear through arm – the patient had accidentally shot himself with a fishing spear! After swimming to his boat, he returned to land and travelled by car approx. 10 miles to ABSAR with the spear still in situ. He was in a lot of pain and needed further assessment by an orthopaedic doctor. An appointment was arranged and pain relief (IM diclofenac and Entonox) administered before bolt cutters were used to remove the barb. The wound had been assessed to establish the likelihood of any arterial damage, which was thought to be low risk. The spear was taken out of the patient's arm, the wound was dressed and the patient made his own way to the doctor in relative comfort. He had complained of pins and needles below the injury but a few days later confirmed this had resolved as soon as the spear was removed.

Sebaceous cyst in ear – the cyst was infected and the ear lobe very swollen. So the lobe was incised and the cyst removed. The wound was packed with gauze soaked in Betadine and dressed. The patient was discharged with advice to return daily to have the dressing/packing changed until the wound had healed.

Cutaneous Larva Migrants – also known as Hookworm. A bite was picked up by a patient on her foot after walking on a beach. Initially itchy and thought to be a mosquito bite, the wound remained itchy and a red line developed from the opening across the sole of the foot. This tracking did not follow the path of the circulation and was raised and hard on palpation. Treatment for this kind of parasite, which is common, is a short course of antibiotic (Mebendozol). This kills the parasite and normally heals without any secondary infection.

Dislocated shoulder – due to a fall from a friend's shoulders during the after race party! The patient was given Nitrous Oxide (gas and air) and 10mg of IM morphine which helped with the pain. The dislocation was reduced in the Medic Centre, but it partially dislocated again. So a sling was applied and the patient went to hospital in a taxi. 

Nitros Oxide - Interestingly, in countries not serviced by BOC distributors, you can’t buy Nitrous Oxide by the brand name of Entonox, as we know it in the UK. This is because BOC holds the patent for the mixing process. Instead, the two gases have to be linked from different cylinders and mixed prior to inhalation. The result is the same but it’s a lot more fiddly!

Lacerations – to knees, eyebrows and foreheads for both local residents and visiting sailors. These had varied causes from slipping and falling on rocks or on the deck of a boat to some party/alcohol related injuries. 

All wounds were cleaned thoroughly with Betadine, sutured if needed and dressed with antibiotic cream. The sutures used are generally not dissolvable so patients are advised to return after a suitable time for removal. This also gives ABSAR a chance to assess for infection. Facial sutures are sometimes carried out by ABSAR, but the patient is always advised about the risks of scarring. None chose to go elsewhere! One patient rather proudly showed us two scars on his other eyebrow and under his chin from previous events requiring facial sutures by ABSAR!

UTI – a visiting sailor was suffering from recurrent UTIs and stopped by for some help. A urine dip test confirmed an infection and the patient was given a course of Trimethroprim (an antibiotic) as she was heading to another location that day. 

Burst eardrum – this was caused by unsuccessful equalising while scuba diving. The patient had already been assessed by a doctor and had just started a course of antibiotics, but was concerned that fluid/pus was still leaking out of his ear. Pain relief advice was given along with decongestants to help his sinuses. Plus advice to return to the doctor if needed.

Rope burn – the burn had actually happened at the start of the race, 5 days previously. But it had been kept clean and dry. It covered an area of approx. 20 cm x 5 cm on the inside of the elbow. It was cleaned with Betadine, dressed with Flamazine (burn cream) and Gelonet to help promote healing, then covered with a water resistant dressing. This sailor was heading off to race elsewhere and couldn’t return, so was discharged with self care advice and a stock of supplies to self-treat.