Poisoning and the MFAG

Poisons on Board: Routes, Effects and Stages

In short: a ship carries fuels, cleaners, paints and cargoes that can poison. Whatever the route in, the first-aid drill is the same.

Three routes into the body

• Inhaled — fumes, gases, vapour in an enclosed space.
• Absorbed — through the skin or eyes after a splash or spill.
• Swallowed — drunk by mistake or on purpose.
• The core management is the same for all three (see the next section).

What a toxic substance can do

• The MFAG lists three main harms: burns, anaphylaxis and asphyxia.
• Poisoning has three stages: latent (no or few signs yet), active (the poison is working) and late (after-effects).

The latent stage fools people: a casualty who looks well can still be seriously poisoned. Methanol is the classic example.

First Response to Poisoning

In short: make it safe, check ABC, stop more poison getting in, find out what it was, and get radio medical advice.

The drill — inhaled, absorbed or swallowed

1. DR BBCFS → ABC — Danger, Response, Breathing, Bleeding/Burns, Consciousness, Fractures, Shock; then airway, breathing, circulation.
2. Remove any contaminated clothing.
3. Identify the poison if you can — ask the casualty early, in case they become unconscious.
4. Collect samples, and send the container with the casualty to hospital.
5. Monitor closely.
6. Not breathing → resuscitate with a BVM (bag-valve-mask).
7. Do NOT induce vomiting.
8. Swab the mouth if it is burning.
9. MAYDAY – TMAS.

Never make the casualty vomit. A corrosive burns twice on the way back up, and a drowsy casualty can choke.

On the bridge

• A crew member is found dizzy in a store after using a cleaner. Get them into fresh air without becoming a second casualty, then run the drill.
• Bring the can or bottle to the radio: TMAS will ask what is in it.

Chemical on the Skin

In short: clothing off first, then lots of running water. Dilution is the answer for both acids and alkalis.

Step by step

1. Remove the contaminated clothing FIRST — soaked cloth keeps the chemical against the skin.
2. Then prolonged running water. Acid or alkali, dilution is the answer.
3. The MSDS goes with the casualty, or is scanned to TMAS.

Know your kit

• Tip: open an expired chemical first-aid kit and learn what is inside before you need it.

Dangerous Goods: the IMDG Code and Hazard Classes

In short: the IMDG Code is the rulebook for carrying dangerous goods by sea. Its class number tells you at a glance what kind of hazard a substance is.

What the IMDG Code is for

• IMDG Code = International Maritime Dangerous Goods Code. Its key aims:
  • protect human life;
  • prevent marine pollution;
  • allow the free movement of dangerous goods.

The nine hazard classes

• Class 6 is the poison class — but gases (2), corrosives (8) and many others can also poison or burn.

The MSDS (Material Safety Data Sheet)

In short: every chemical on board has a data sheet. In an emergency go straight to section 8 — first aid.

The nine sections

• Section 8 usually ends with “contact a doctor”. At sea, that means TMAS (radio medical advice).
• Section 2 gives you the ingredient — the name you need for the MFAG.

The MSDS goes with the casualty, or is scanned and sent to TMAS.

Using the MFAG and the Ship Captain’s Medical Guide

In short: the MFAG gives the first aid for each dangerous substance. Search it by ingredient, never by trade name.

What the MFAG is

• MFAG = Medical First Aid Guide for Use in Accidents Involving Dangerous Goods — an IMO/WHO/ILO guide, printed in the IMDG Code Supplement.
• It has poison tables by ingredient: signs, symptoms and treatment for each.

How to look a substance up

1. Read the label or the MSDS for the ingredient.
2. Find that ingredient in the MFAG — not the trade name. Example: a degreaser contains methanol, so look up methanol.
3. Follow the table, and get radio medical advice (RMA).
4. Cross-check the Ship Captain’s Medical Guide (SCMG): methanol and ethylene glycol are on p. 178; the allergy section is around p. 42 (5.15).

• Practise finding answers in the SCMG before an emergency: in a real case you have no time to learn the book.

Methanol and Ethylene Glycol

In short: methanol (found in degreasers) is highly toxic and acts late. Ethanol is the antidote: it blocks methanol uptake and buys time until evacuation.

Why it is dangerous

• Highly toxic, with a delayed effect.
• The casualty can look fine at first. Don’t wait for symptoms — treat on the history.

The antidote — two sources, two doses

• Both work the same way: ethanol blocks methanol uptake and buys time.
• The doses differ between the two books: follow the one TMAS tells you to use.

Ethanol is the methanol antidote. It does not cure — it holds the poison back until the casualty reaches hospital.

Anaphylaxis

In short: a severe, fast allergic reaction that closes the airway and drops the blood pressure. Adrenaline first, then antihistamine and steroid, and keep treating for days.

Recognise it

• Example: a guest takes one bite of a clam and soon shows signs of shock, difficulty breathing and a rapid loss of consciousness.
• Airway swelling or breathing trouble → adrenaline.
• Small local sting → cortisone cream only, NO adrenaline.

Treatment step by step

1. Adrenaline IM: 0.5 mg adult / 0.3 mg child. Repeat every 5–10 min if there is no improvement.
2. EpiPen: take the blue cap off → press into the upper outer thigh, through clothing → hold 10 s. For repeat doses alternate thighs and record which side.
3. Shock position + oxygen; IV fluids if the blood pressure stays low.
4. Then give both an antihistamine (stops the reaction) and a steroid (clears the inflammation already there). Salbutamol only if wheezing.
5. Continue treatment for 4–7 days, or the allergy can rebound worse. SCMG allergy section ≈ p. 42 (5.15).

Adrenaline in the medical stores

• Adrenaline is kept with the cardiac drugs.
• Ampoules are 1 mg in 1 ml. IM and IV preparations differ — dilute to draw up the dose accurately.

Don’t stop at adrenaline. Give antihistamine and steroid, and keep treating for 4–7 days.

Asthma and Inhalers

In short: in asthma the airway muscles tighten. An inhaler relaxes them and usually eases the breathing.

Reliever and preventer

• An inhaler relaxes the muscles in the airway walls — usually effective for breathing difficulty in asthma.
• Reliever = Ventolin (salbutamol) — for the attack.
• Preventer = a daily steroid inhaler — keeps attacks away; it does not stop one in progress.
• Severe asthma in hospital: continuous nebulised salbutamol + IV magnesium sulfate (hospital care, beyond on-board treatment).
• Asthma and allergy overlap: in anaphylaxis, salbutamol is added only if there is wheezing.