Position casualty; immediate measures in medical emergencies
Governing: STCW Table A-VI/1-3; Resuscitation Council UK 2025 First Aid guidelines. Builds on: L2.1.
Unconsciousness
An unresponsive casualty cannot protect their own airway. The tongue can fall back, and vomit can be inhaled.
- Check breathing. If not breathing normally, start CPR (L2.1).
- If breathing normally but unresponsive, call for help and place them in the recovery position.
Recovery position
RCUK 2025: place adults and children with a decreased level of responsiveness who do not meet the criteria for CPR in a lateral (side-lying) position.
- Kneel beside them; straighten their legs.
- Place the near arm at right angles to the body.
- Bring the far arm across the chest, back of the hand against the near cheek.
- Bend the far knee up and roll them towards you.
- Tilt the head back to keep the airway open.
- Monitor breathing continuously.
CAUTION — When not to RCUK 2025: do not use the recovery position with agonal breathing (that is cardiac arrest; start CPR) or trauma (suspected spinal injury; see L3.1).
Choking
RCUK 2025 adult choking:
| Step | Action |
|---|---|
| Recognise | Suddenly unable to speak or cough, especially while eating. Ask: "Are you choking?" |
| Mild | Can cough: encourage coughing |
| Severe | Cannot cough, or cough ineffective: up to 5 back blows between the shoulder blades, casualty leaning forward |
| Still choking | Up to 5 abdominal thrusts: stand behind, fist above the navel, pull sharply inwards and upwards |
| Still choking | Call for help and alternate 5 back blows and 5 abdominal thrusts |
| Unresponsive | Start CPR; make sure help is called |
Do not use blind finger sweeps. Anyone treated with abdominal thrusts or chest compressions needs medical evaluation; RCUK notes complications and injuries can occur. RCUK found insufficient evidence to recommend for or against suction anti-choking devices.
Sudden illness
| Condition | Recognise | RCUK 2025 first aid |
|---|---|---|
| Chest pain (cardiac) | Crushing central pain, may spread to arm or jaw; sweating, breathlessness | Reassure, sit comfortably, call for help; help them self-administer 300 mg aspirin unless allergic; help with their own angina spray |
| Stroke | FAST: Face drooping, Arm weakness, Speech problems, Time to call | Call for help urgently; note the time symptoms started |
| Hypoglycaemia | Diabetic or malnourished, with sudden confusion or behaviour change | If awake and can swallow: 15-20 g glucose tablets, or sweets or juice; repeat after 15 min if no better; snack after recovery. Nothing by mouth if unresponsive |
| Anaphylaxis | Breathing difficulty, swelling, rash, faintness after a known trigger | Call for help; lie down (sit if breathless); remove trigger; adrenaline autoinjector into outer thigh; second dose after 5 minutes if no better |
| Asthma | Wheeze, breathlessness | Help them use their own reliever inhaler, with a spacer if available |
WARNING — Allergies on charter Guest preference sheets list allergies for a reason. Know which guests carry autoinjectors and where they keep them.
Seizures
Protect from injury: clear the space, cushion the head, do not restrain, put nothing in the mouth, and time it. Afterwards, if breathing normally, recovery position and monitor. Get help for a long seizure, repeated seizures, injury, or a first fit.
Fainting
A faint is a brief loss of consciousness that recovers quickly when lying flat. If recovery is not quick, treat as unconsciousness.
TIP — Write the time down Stroke, seizures and anaphylaxis treatments all depend on times. Note them as they happen.