ESTABLISHED by Sir William Hillary in 1824 when the seas around the British Isles were crowded with small sailing vessels, fishing and carrying cargoes, the R.N.L.I. was primarily concerned with saving lives from shipwreck. One of the original suggestions of the founder was that a doctor should be attached to each life-boat station; and although many doctors around the coast have joined in the work it was not until after the last war that it became the general policy of the Institution that each station should have an honorary medical adviser. Un- doubtedly this has had the effect of raising the standard of first aid among the life-boat crews.

Apart from calls that result in the life-boat rendering no service at all and those numerous occasions when cold, lost, frightened and bruised survivors are given general attention, first aid in some form is required in about one fifth of the services (90-100 a year). On half these occasions there is enough warning for a local doctor to go out with the boat. As a rescue service the R.N.L.I.'s medical problems are not with the long-term survival of cast- aways, but with resuscitation, first aid during the journey to port, and the movement of casualties often in very difficult conditions.

Calls Through Medico Service Calls for service generally come to R.N.L.I. stations through the Coast- guard, and these include a number that have originated in the G.P.O. Medico Service for ships at sea. By this radio telephone service the G.P.O. provides a rapid means for ships to obtain medical advice and assistance.

On the occasions when there is a doctor on board the life-boat, which number 45-50 a year, he will be able to perform or direct the resuscitation and * This article is reproduced by kind permission of Medical News.

treatment, but there remain a number of occasions when the crews, being iso- lated, must know how to deal with emergencies themselves, though of course it is often possible for them to obtain advice from a doctor on shore over the radio-telephone.

The R.N.L.I. boats, except for a few fast dinghies mentioned later in the article, are all between 35 ft. 6 in. and 52 ft. long, built of wood, of shallow draft and very buoyant. They are there- fore very lively, and the extremely violent movements they perform in a heavy sea both hamper and limit the first aid measures that can be under- taken.

Training of Crews In order that the crews may be as well equipped as possible to preserve the lives of those they rescue the Institution does all it can to encourage at least two members of each crew to obtain first aid certificates from the St. John Ambu- lance or equivalent organizations, and provides a first aid book written with the special conditions in mind.

For moving casualties the Neil Rob- ertson stretcher, which can be folded and stowed in a small space, is found the most practical. This stretcher, prop- erly applied, prevents the patient from taking panic action which might en- danger his life, and can be easily handled during transit from one vessel to another, or when lifted to a helicopter.

It has been used as a strait-jacket to restrain a lunatic in transit to the shore.

The relief obtained when becoming airborne on the way to a helicopter, after being carried in a stretcher on board a buoyant life-boat, has to be experienced to be appreciated. There is no doubt that a helicopter gets the patient to hospital in better condition, and this advantage is further increased if a long road journey by ambulance can also be eliminated. Fortunately there is very good co-operation between the service helicopters round our coasts, the Coastguard and the Royal National Life-boat stations, and thanks to mod- ern radio equipment we are able to keep in direct communication with each other when on service.

Authority for Morphine Doctors who go out with life-boats take with them what they require, be- cause on board there is no more than the usual simple equipment a first aider can use. But in some boats, whose first aiders have received special instruction from their medical advisers, thus ful- filling regulations, authority has been given by the Home Office to carry morphine in the form of tubunic am- poules containing grain of Omnopon.

As more and more crews become quali- fied it is hoped that nearly all those seriously injured at sea will be able to obtain relief before reaching shore.

The whole crew is trained in resus- citation. They are taught both the "kiss of life" and the Holger Nielsen methods of artificial respiration. The mouth-to- mouth or nose-to-mouth methods are taught by means of the Resusciannie Mannikin. Great stress is laid upon the importance of beginning resuscitation immediately as a matter of the greatest urgency, if possible even before the patient is lifted from the water. By virtue of their waterside work life-boat- men find opportunities of saving lives with artificial respiration quite apart from their life-boat services, and at the end of last year one of them received the Royal Humane Society's medal for re- suscitating a man found floating face downwards in the water.

Cramped Conditions on Board It is not easy to accomplish artificial respiration by any method in the cramp- ed conditions on board a life-boat which is being tossed on a rough sea, so in order to make the mouth-to-mouth, or expired air, method more practical in these conditions every life-boat carries a simple piece of apparatus. This consists of a Brooke airway connected by a piece of unkinkable anaesthetic tubing to an inspiratory valve and mouthpiece which can be gripped in the rescuer's teeth. By this means the first aider can perform expired air artificial respiration with his head moving independently of the patient's head and with both hands free to maintain the position of the patient's jaw and the airway. With this apparatus artificial respiration can also be maintained while the patient is being carried on a stretcher.

Since oxygen is the most efficient gas with which to give artificial respiration a number of life-boats have been equip- ped to deliver oxygen at 7 Ibs to the square inch to three or four points on the boat to which a tube leading to a mask can be plugged.

In recent years there has been a great increase in the number of holiday- makers using our shores and coastal waters with a corresponding increase in the number of accidents happening to inexperienced bathers, boaters and cliff clamberers.

New Medical Problems Many of these have such rapidly fatal results, even in calm weather, that only fast boats in the right place can hope to get there in time. For this reason the Institution has begun to operate rubber dinghies with outboard motors capable of doing over 20 knots. These very fast rescue craft, which have already saved lives, have an action when at speed even more violent than the ordinary life-boat, and it will be of interest to see what new medical problems they bring to light.

The following stories of accidents have been extracted from the Institu- tion's records and serve to illustrate the kind of work done.

On October 30th, 1960, the coast- guard informed the coxswain of the Humber life-boat that a trawler with an injured man was making for the Humber and that the services of a doctor were urgently needed.

Three quarters of an hour later, at 3 p.m., the life-boat was launched with a doctor, who had ten miles to come. She met the trawler 25 miles from Spurn Point and put the doctor on board. It was too rough for the patient, whose arm was severely injured, to be trans- ferred to the life-boat till they were under the shelter of the land. Once in the life-boat the patient was given a saline drip and injection by the doctor and he was later landed at Grimsby and taken to the hospital. The life-boat returned to her base just after midnight, the doctor probably after 7 a.m.

The patient had to have his arm am- putated but made a good recovery.

Dutch Vessel on Fire On December 8th, 1962, in a rough sea, the Dutch motor vessel Temar was on fire and the Southend-on-Sea life- boat was launched. A tanker, two tugs, and a local boat had gone to the help of the Temar, who reported she did not need the life-boat. Nevertheless the cox- swain took the decision to continue as he believed lives might be in danger.

He circled the Temar, and as he did so a man's head could be seen jammed in a cabin port-hole. A ship's boat had already put aboard the tanker's chief engineer and others with an asbestos suit and oxygen breathing apparatus, but they could not reach the man.

Although the wind had increased to a gale the coxswain was able to secure the life-boat in the lee of the Temar and just below the man's head.

Two members of the crew boarded the Temar and took turns at keeping the man's head out of the port-hole by pulling on his ears while the coxswain and motor mechanic, although hindered by smoke, administered oxygen each time the life-boat came up on a wave.

Equipment from one of the tugs was used to cut away the deck above the cabin and a jet of water was played on the man to protect him from the effects of the molten metal falling on his back.

This enabled the chief engineer of the tanker in an asbestos suit to pull him from the cabin.

Call to Norwegian Vessel The life-boat then took him to South- end where a doctor gave morphia.

He was lifted ashore on a blanket to prevent pressure on his burns and ad- mitted to hospital.

At 8.45 p.m. on April 14th, 1963, the honorary secretary of the Moelfre life- boat was informed by the coastguard that a Norwegian vessel had a sick man on board who needed a doctor. There was a strong gale from the south-west and a rough sea. At 9.5 p.m. the life- boat was launched with a doctor on board, who boarded the motor vessel and decided to land the sick man. He was taken on board the life-boat with difficulty as the motor vessel was drag- ging her anchor. Weather conditions were too bad to land the patient either at Moelfre or Beaumaris and the life- boat then made for Menai bridge pier, where the patient and doctor were trans- ferred to a waiting ambulance. When the weather moderated the life-boat returned to Moelfre, arriving at 8,0 a.m.

next day.

At 7.0 p.m. on May 18th, 1963, the Howth life-boat went to a cliff accident.

There was a westerly gale and a high sea.

With a small boat in tow they soon reached the scene. The small boat went close inshore with a stretcher, with which they were able to bring an in- jured boy to the life-boat, together with three firemen who would have had difficulty in climbing the cliff again. They took the patient back to Howth harbour pier, where he was transferred to an ambulance.

Landed by Helicopter On May llth, 1963, the Eastbourne life-boat was launched in a very rough sea with an honorary medical adviser on board and proceeded to the s.s. Onshun, where a man had received severe burns.

The doctor went on board the steamer, and in view of the man's injuries and the prevailing weather conditions ar- rangements were made for a helicopter to land both injured man and doctor.

On May 13th, 1963, as no other boat was available the Galway Bay life-boat was launched in a very strong westerly wind and a very rough sea to take a dangerously ill woman from Aran to the mainland at Rossaveel.

When the life-boat reached the main- land a team of doctors with a special ambulance were waiting to perform an emergency operation on the woman, who was then taken to hospital.