Scenario – Male snorkeler floating unresponsive in water, following likely intracerebral event.

Scene – Offshore recovery. Strop winch by paramedic into aircraft with initial assessment on board then further assessment and treatment at landing site on nearby headland.

Patient – Cold and wet in wetsuit. Poor airway control. Poor ventilation. Weak pulse. Progresses to seizures and recurrent vomiting.

Challenges – Airway control, vascular access, seizure management, requirement for RSI.

Learning points from debrief for clinical practice :

• Preparation of the cabin for any water-based primary mission including doctor on wander lead, O2 and LMA out ready to go, access to suction and potential for two points of suction to be required
• Difficulties in assessment and monitoring of the cold, wet patient
• IO access through a cut wetsuit point
• Seizure control options including intraosseous, intramuscular and intranasal benzo usage

Learning points from debrief for Simulation practice :

• Combining medical scenario with full strop winch training a worthwhile activity

Thanks to  John  (doc),Hugh(para), Shane(pilot), Richo(aircrew), Einar(actor),      Fergal (SRC),   Luke (STAR)