Medical emergencies
Governing: Table A-VI/4-2 'diseases, including medical conditions and emergencies'; RCUK First Aid Guidelines 2025; MSN 1905 Amendment 5, Annexes 2 and 7.
Chest pain
| Recognition | Action (RCUK 2025) |
|---|---|
| Central chest pain or pressure, may spread to arm, jaw or back; sweating, nausea, breathlessness | Sit or lie comfortably, reassure, call for advice |
| 300 mg aspirin, ideally chewed, unless known allergy | |
| Help a known angina patient use their own nitrate spray or tablets | |
| Oxygen only if hypoxic; AED close by | |
| Record pulse, BP and SpO2 regularly |
If they collapse and stop breathing normally, start CPR and use the AED (MFA lesson 1.2).
Stroke
FAST: Face drooping, Arm weakness, Speech disturbance, Time to call. RCUK 2025 says use a recognition tool and give oxygen only if trained and the person shows signs of hypoxia. Record the time of onset or when last seen well; it decides hospital treatment. Nothing by mouth until swallowing is checked. Do not give aspirin for a suspected stroke without medical advice. Most strokes at sea mean evacuation.
Diabetic emergencies
| Hypoglycaemia (low) | Hyperglycaemia (high) | |
|---|---|---|
| Onset | Minutes | Hours to days |
| Signs | Sudden behaviour change, confusion, sweating, pallor, falling response | Thirst, passing urine, drowsiness, deep breathing, fruity breath |
| Action | 15-20 g oral glucose if awake and able to swallow; test and treat if below 4.0 mmol/L; repeat after 15 min if not improving; snack once recovered | TMAS; monitor; recovery position if drowsy |
| Unresponsive | Nothing by mouth; recovery position; TMAS | Same |
If unsure which, treat as low: sugar will not seriously harm a high patient, and a low patient can die.
Anaphylaxis
Suspect it with breathing difficulty (stridor or wheeze), flushing or hives, cold clammy skin or faintness, abdominal symptoms, after exposure to a food allergen, sting or medicine.
- Remove the trigger if possible.
- Intramuscular adrenaline into the outer thigh as soon as possible (auto-injector or ampoule, as carried).
- Lie flat, or sit with legs out if breathing is difficult.
- Second dose after five minutes if no improvement, ideally in the other leg.
- Oxygen, TMAS, and observe: symptoms can return.
MSN 1905 Annex 7 lists adrenaline for anaphylaxis or resuscitation only, and the Immediate Response Bag carries it.
Asthma
Help them use their own reliever inhaler, through a spacer if available. Sit upright. Severe attacks (unable to speak, exhaustion, falling SpO2) need oxygen and urgent TMAS.
Oxygen
RCUK 2025: titrate to SpO2 94-98%, or 88-92% in chronic obstructive pulmonary disease. In life-threatening hypoxaemia (below 88%), give high-flow oxygen to everyone.
WARNING — Guest allergies The preference sheet's allergy line is a medical document. The chef, chief stew and PMC holder all need to have read it, and the adrenaline needs to be where the guests eat.
TIP — Seizures Protect from injury, do not restrain, nothing in the mouth, recovery position afterwards, time the seizure, and call TMAS for a first seizure or one lasting more than a few minutes.