TO OUTLINE ALL the work of the Medical and Survival Committee would take too long, so the following paragraphs will contain accounts of activities selected because they are likely to be of general interest and, where necessary, explanations of the reasons behind the policies adopted will be given.

The teaching of first aid has been improved by the acquisition of two Royal Navy films, 'Emergency Resuscitation' and 'Cold Can Kill'. Both these are available, by arrangement, for show at any lifeboat station, and whenever they are shown their quality and material is always greatly appreciated.

In May 1975 a new edition of 'First Aid for Lifeboat Crews' was issued which confines itself to those subjects that are of special importance in lifeboat work. There are chapters on Personal Health, Hypothermia, Asphyxia and Resuscitation (copied verbatim from the St John First Aid Manual), a specially written chapter on Resuscitation in Lifeboats, Handling and Transport of Injured Persons and Morphia.

As mentioned in Part I of this article, published in the winter issue of THE LIFEBOAT, the committee carefully monitors developments in the field of resuscitation and the recent work done in Edinburgh on the treatment of hypothermia by the provision of hot, wet air for the casualty to breathe has shown that this is certainly practical in hospitals. Research has now begun, on behalf of the RNLI, at Edinburgh and Newcastle which will attempt to modify a type of resuscitation apparatus to enable it to be used for rewarming cases of hypothermia; but whether the ideal of an apparatus that can be successfully used by first aiders in ILBs is really feasible yet remains to be seen.

In recent years many new designs of stretcher have been produced in this and other countries, and as far as possible all these are inspected by the committee and those that seem to have a possible application to lifeboat needs are further investigated. None of those seen has seemed better than the very versatile Neil Robertson stretcher supplied to 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.most conventional lifeboats, which can be used for moving casualties up and down companion ways, through narrow hatches, from one vessel to another and for lifting them to helicopters. The committee's attention to this subject has led to the introduction of carrying sheets for casualties in ILBs, and to the inclusion in the first aid book of advice on the best method of transferring casualties in a stretcher from one vessel to another.

Exercises with helicopters are of great importance if lifts of casualties, or other personnel, are to be undertaken safely.

Up to now there have been differences in equipment and the procedures required by the RAF and the Navy, but it is hoped that discussion now in progress will lead to greater standardisation both of equipment and procedures.

In the realms of personal equipment for crews, the history of the development of the lifejacket has already been dealt with, but a great deal of work has also been done in order to arrive at the best type of protective clothing. A two-piece suit which can be worn over normal clothing and thigh boots is now in general use by crews of conventional lifeboats. But the varying conditions and preferences have so far stood in the way of adopting a universal suit for ILB crews. In the interest of economy it is hoped that this will eventually be achieved.

The application of the scheme of medical standards and examinations accepted in 1970 has proceeded quite smoothly though some have criticised the standard of vision required for coxswains and others as being too severe; so it may be as well to explain now that the vision required is the same as that recommended to the Department of Trade in 1970, by a panel of experts, as necessary for 'Masters and Mates in the Merchant Navy, or Skippers and Second Hands in the Fishing Fleet'. No search and rescue organisation like the RNLI could accept a standard of vision lower than that required for the skipper of a fishing boat, and coxswains (and others) in conventional lifeboats may achieve the standard with the aid of spectacles. For inshore lifeboats, however, the standard, which is good normal vision, has to be reached naturally without sight aids. This is necessary because the crews of ILBs are only just above the surface of the sea and so exposed to wind and spray that spectacles would often be no aid to vision and contact lenses in danger of displacement.

General medical examinations are carried out not with the intention of rejecting all who do not have perfect physique, but with the intention of making as sure as possible that men accepted are not suffering from conditions that may cause a failure during service, resulting in danger to those being rescued or taking part in the rescue; or from conditions that may be aggravated by service in very cold or bad weather and endanger a man's future health. The examiner also has to consider whether the effects of any treatments prescribed for reported conditions could produce side-effects during service which would reduce a man's efficiency.

The committee's intention is that all medical examinations should be undertaken by the station honorary medical adviser, because this will help the relationship between doctor and crew, but the final decision on the recommendation to accept or reject is made by one of the Institution's medical referees.

This arrangement relieves the station doctor of making decisions about his neighbours or patients to which they might take exception.

Meetings between station honorary medical advisers have always been thought very valuable, but the expense of arranging formal gatherings has made this impossible. However in recent years the Medical Commission on Accident Prevention has arranged symposia on the broad subject of prevention of, and immediate care at, accidents. Doctors have been entitled to claim their expenses from the National Health Service, and it has been possible for honorary medical advisers attending to be gathered to private meetings at which the discussions have proved valuable, both at the time and {Continued on page 138).