ALTHOUGH THERE HAVE BEEN instances of medical men serving on the Committee of Management in years gone by, and many occasions when doctors on the coast have given valuable service, there was never a centrally planned policy on medical arrangements in the RNLI until shortly after the last war when a doctor was appointed to the Committee of Management in order to achieve this object. Our founder, Sir William Hillary, had expressed the wish that every lifeboat station should have a local doctor formally attached but this did not become general policy until the early 1950s when it was decided to appoint an honorary medical adviser to each lifeboat station. With this beginning it became possible to improve the general standard of first aid among crews by the issue of the first 'First Aid for Lifeboat Crews'.

These steps were welcomed on the coast, where many members of the local branches and the crews had seen the benefits of first aid and medical organisation during the war, both in Civil Defence and in the armed forces.

Later in the 1950s Professor E. A. Pask was recruited to the Committee of Management. At that time he was Professor of Anaesthetics at Newcastleupon- Tyne, but during the war he had not only served in the RAF as an anaesthetist, but also in the Institute of Aviation Medicine where he was engaged in research on resuscitation and on the design of lifejackets. So great was his dedication that during both these projects he volunteered to be the unconscious guinea-pig on which tests were made. During the former project his anaesthesia was taken to the depth at which his spontaneous breathing ceased and then fellow workers maintained his life with artificial respiration while observing which method was the most efficient. Of course at this date the 'kiss of life' was not in use and the comparisons were principally between the Schafer, Sylvester and Eve methods.

During the latter project Professor Pask wore an RAF lifejacket and, while anaesthetised, he was placed in a swimming pool, thus enabling his Dr Hale has been a member of the Committee of Management since 1952 and was elected a vice-president in 1964. He served on the medical working parties and is a member of the Medical and Survival Committee, of which he was chairman from its formation in 1971 until 1975.

colleagues to observe just how an unconscious man floated, and how the lifejacket could be modified to increase its efficiency.

Professor Pask came to the Institution with this experience at a particularly appropriate time, when all the maritime countries were becoming aware that oil pollution at sea was an increasing threat to the buoyancy of most of the lifejackets then in use.

This threat led to modifications to the RNLI lifejacket then in use, and in 1963 the Committee of Management set up a working party to advise on the design of a new lifejacket for the Institution.

Soon the working party was strengthened by the inclusion of Surgeon Captain F. W. Baskerville, CBE, then a serving Naval officer, and an expert on survival at sea.

Professor Pask had designed an anthropomorphic dummy which did away with the need for human guineapigs.

Both at Littlehampton and off Tynemouth, watched by inquisitive seals, the working party spent days at sea observing the performance of the dummy in various designs of lifejackets from several countries. Finally the more promising models were tested on conscious human subjects in the wave tank at Haslar. From all these observations and after much other work on materials and details of manufacture the present RNLI lifejacket was evolved.

While this work on lifejackets was going on much thought was also being given to the resuscitation of the apparently drowned. In the 1950s the Holger-Nielson method of artificial respiration had replaced the older methods, and as a 'spin off' from the great strides made in anaesthetic apparatus several types of more or less automatic resuscitation machines, using bottled oxygen, came on the market.

But none of these were really suitable for first aiders to use in the rough and wet, salt conditions of the RNLI boats, where proper maintenance was always a problem because of the corrosive qualities of salt water.

In 1960, in the hope of solving some of these problems, Professor Pask designed a method of piping oxygen to three points on a lifeboat, into which the 'business end' of a resuscitator could be plugged. This apparatus was fitted into 12 conventional lifeboats.

It was in this same year, 1960, that the 'kiss of life' was recognised as the most efficient non-mechanical methodof artificial respiration and generally adopted by all first aid organisations.

During the next seven years the Institution watched for results from the 12 boats equipped with oxygen, and from the remainder of the fleet which used mainly the 'kiss of life'. Interest was added to this comparison by the introduction of the fast inshore lifeboats in 1963 which gave crew members opportunities to reach an inshore casualty soon enough for artificial respiration to be effective.

In these ILBs, and to a lesser extent in conventional boats, the actual giving of the 'kiss of life' is made difficult by physical problems not the least of which is for the first-aider to keep his mouth against that of the casualty when the latter is lying on a heaving deck. A mouthpiece for the first-aider, joined by flexible tubing to a Brook Airway for the casualty, has got over this problem and with valves built into the mouthpieces it makes the 'kiss of life' the method of choice for emergency resuscitation in lifeboats.

The invention of this simple aid to the 'kiss of life' method of artificial respiration was the last of many valuable items of work that Professor Pask completed for the Institution before his tragic death in 1966 at the early age of 53. For his bravery during his research projects, from which the RNLI later benefitted so greatly, he was posthumously awarded the Institution's silver medal in 1967.

By 1967 no resuscitation had been achieved by the piped apparatuses, which had still proved difficult to maintain besides presenting certain fire risks.

So in this year the Committee of Management decided to remove them and set up the oxygen working group to advise on the need for oxygen and the best method of resuscitation in lifeboats.

This group recommended that oxygen resuscitation apparatuses should not be (Continued on page 91).