Medical Emergency at Night with a Suspected Cardiac Case

This is a time-critical suspected myocardial infarction. Priorities:

1. Keep the patient at rest, sitting up if that eases breathing, and reassure him. Do not let him walk. Reduce physical exertion.
2. Give oxygen if available and if his oxygen saturation is low or he is breathless - titrate to effect rather than giving high-flow oxygen routinely to a patient with normal saturations.
3. Aspirin: unless there is a known allergy or active bleeding, give a single dose (typically 300 mg chewed) as soon as possible - this is a recognised early intervention in suspected heart attack.
4. GTN: if the patient has chest pain and no contraindication (e.g. low blood pressure, recent use of erectile-dysfunction drugs), GTN may be given sublingually as directed by medical advice. Blood pressure should be checked first if possible.
5. Monitor: pulse, blood pressure, respiratory rate, level of consciousness, and pain score, recorded at regular intervals. Attach the AED and be ready to use it if he becomes unresponsive and not breathing normally.
6. Call for medical advice via the appropriate telemedical service (e.g. TMAS) and follow their guidance - they can authorise medication and advise on evacuation.

I would document times, symptoms, observations and all treatment given.

The decision is a risk-benefit comparison, made with medical advice:

• Clinical urgency: suspected MI with ongoing pain is a high-risk condition; deterioration, arrhythmia or cardiac arrest can occur within hours. A 14-hour passage to port is a long time for a patient who may need reperfusion therapy.
• Helicopter: 3 hours to reach the vessel. It gets the patient to definitive care much sooner. But it depends on weather (wind force 5, moderate sea - likely feasible but the helicopter operator decides), daylight (it is 23:40, so night operations), the vessel's ability to provide a clear deck and lighting, and the patient's stability for transfer.
• Proceeding to port: keeps the patient on board with the ship's limited resources, but is slower. It may be the only option if the helicopter cannot launch.

My recommendation would be to request the helicopter evacuation while simultaneously making best speed toward port, so that if the helicopter is unavailable or delayed, the vessel is already closing the distance. I would consult TMAS for the clinical view and let the master make the final decision with that advice. I would prepare the patient for transfer: keep him warm, continue monitoring, have the AED and oxygen ready, and brief the crew on the transfer procedure.

Preparation for a helicopter winch/hoist:

• Communications: establish radio contact with the helicopter on the agreed frequency, confirm the vessel's position, course, speed and the intended hoist area.
• Ship handling: the master would steer to provide a lee and a steady course, reducing speed as directed by the helicopter crew, and keep the hoist area clear of obstructions, rigging and exhaust.
• Deck: clear the hoist area, mark it, provide lighting at night, secure loose gear, and have a stretcher, blankets and the patient's medical notes ready. Assign a deck team with a leader, and brief them on hand signals and the danger of static electricity.
• Patient: secure the patient in a stretcher or rescue harness as advised, with monitoring continued until handover.

Records to keep: a timed log of symptoms, observations (pulse, BP, respiration, consciousness), all medication given and by whom, advice received from TMAS with the time and the adviser's name, the decision-making around evacuation, the helicopter's details and time of handover, and a copy of the medical notes to send with the patient. These records protect the patient's continuity of care and are essential for any subsequent investigation or claim.