The type of work conducted on board and the many confined spaces may lead to head injuries, among other hazards. In fact, head injuries is one of the common injuries for crew members while on duty due to failure to use safety equipment (helmets); inappropriate or damaged PPE; slip and fall accidents; accidents involving cranes and cargo; and improperly stored equipment.
There are two (2) types of common head injuries
- Closed: A closed head injury is when an injury occurs, but the skull is not broken, fractured, or pierced.
- Penetrating: Also called Open head injury and occurs when the skull is penetrated, pierced or fractured.
All head injuries are serious due to the risk to the brain, but often closed head injuries are more difficult to be diagnosed. Overall, head injuries can be dangerous and require immediate medical care with extended observation.
What to be aware of
Caution is required as some head injuries may not seem serious at first. The symptoms that should alert the seafarer and medical officer onboard may be:
- A persistent headache that won’t diminish
- Chronic vomiting and/or nausea
- Dilated pupils
- Unexpected seizures, especially if they never existed before
- Convulsions
- Disorientation and/or confusion
- Weakness and numbness in the arms and legs
What to do
- check for other injuries, especially of the neck or spinal cord and also for bleeding wounds
- Place an unconscious seafarer in the coma, or recovery, position, unless you suspect spinal injury
- Check for an obvious compound skull fracture
- Check seafarer’s tetanus immunization status if there is an open wound
- Use the Glasgow Coma Scale (GCS) of Medical Guide onboard Ships to assess the degree of impairment of consciousness, which is the most important outcome of traumatic brain injury.
The Glasgow Coma Scale
The Glasgow Coma Scale (GCS) is a neurological scale which aims to give a reliable and objective way of recording the state of a person’s consciousness for initial as well as subsequent assessment. A person is assessed against the criteria of the scale, and the resulting points give a person’s score between 3 (indicating deep unconsciousness) and either 14 (original scale) or 15 (more widely used, modified or revised scale).
If the Glasgow Coma Scale score is less than 13 when measured at 30 minutes after the injury, it is important to seek medical advice with a view to urgent evacuation. Also, do not give anything by mouth and do not give morphine unless there is severe pain from other injuries;
If you give morphine, note down that you have done so, together with the dose, time, and route of administration both in the patient’s medical record and, using a waterproof indelible marker, on a conspicuous part of the patient’s body away from major wounds (forearm, chest, or forehead).
Furthermore, seek medical advice about the advisability of evacuation even if the Glasgow Coma Scale score is 13 or more but the patient is over 65; or fell onto the head from a height of more than one metre or down four or more stairs.
