One of the key people at every lifeboat station is the honorary medical adviser, a local general practitioner who takes into his care the routine medical oversight of boat and crew and who, while not necessarily required by his appointment to go to sea, is nevertheless ready, on call, to embark on service if severe injury has been reported and a doctor is needed. Much of the background to the work of this body of men and women, affectionately known as 'lifeboat doctors', was described by Dr Geoffrey Hale, member and former chairman of the Institution's Medical and Survival Committee, in articles published in numbers 454 and 455 of THE LIFEBOAT. But let us now look more closely at the work of one . . .

HMA ROBERT HAWORTH, MRCS LRCP DAEng, OF BARMOUTH CREW MEMBER, HONORARY MEDICAL ADVISER AND SILVER MEDALLIST ' We are all specialists in accidents. We have to be.' ROBERT HAWORTH, a crew member and honorary medical adviser (HMA) of Barmouth lifeboat station, is one of four doctors in practice in this little Welsh port at the heart of what might be called a geographical first aid area.

Barmouth is the largest town of an isolated strip of coastline, bounded on one side by the waters of the Irish Sea and of the estuary of Afon Mawddach, and on the other side by the foothills of of the Rhinnog Mountains. By road, skirting the mountains, it is 20 miles north along the coast to Harlech, ten miles east back along the edge of the estuary to Dolgellau. The nearest hospital is at Bangor; that means 53 miles by ambulance or a helicopter flight from the little Llanbedr airfield.

So there is no local hospital, no easily accessible casualty department, while, at holiday times, the accident rate is abnormally high.

In winter the practice has in its care some 5,000 people living in Barmouth or Dyffryn, scattered along the coast or on the farms of the valleys running up from it. In summer holiday months, however, the population can rise to more like 100,000. Many of the visitors are totally new to this sort of area, but undaunted by the majesty of scenery, their enterprise often carries them beyond the limits of their experience.

They climb mountains, take to the sea, unaware of the danger signs of the changing moods of nature, and inevitably some of them run into trouble.

Casualties, in fact, form half the summer work of the four doctors, and they in turn, with senior partner Dr Merfyn Jones at their head, are leaders of what amounts to a community first aid team. Between them, the four partners are medical officers to the lifeboat service, to mountain rescue teams, to the fire service and to Llanbedr airfield (they even have to know how to de-fuse the ejector seats of jet aircraft— it would be so fatally easy, while climbing in to tend a trapped pilot, to hang on to the wrong handle). For the members of all these services and for the general public they run regular first aid courses.

The people of Barmouth understand the problems of isolation. They know that, with no local hospital, whatever the accident it will have to be dealt with by local people and, even if they are not called upon to give active help themselves, they give their full co-operation.

Robert Haworth remembers one of the very first times he went out on service in The Chieftain, Barmouth's 35' 6" Liverpool lifeboat. He was just wiring up a patient for an electrocardiogram when the maroons went up. 'Go on, clear off!' said the patient, a boating man himself, and lay there quietly waiting for an hour until the doctor came back. It is all part of the life of Barmouth.

In their teaching, the doctors aim to bring first aid down to first essentials, dividing it into two categories: immediate, lifesaving care about which there must be no hesitation, to be followed by first aid for injuries like broken limbs which can be approached with less urgency. Emphasis is put on simplicity; the first aider will be shown routine treatments which can be put into practice without the need to make a definite diagnosis of the full extent of the injury; after all, even a doctor cannot always tell whether, for instance, there has been a fracture without an x-ray. By this system a sprain may well, of course, receive the same treatment as a fracture but, nevertheless, had it been the more serious injury it would have been given adequate care.

Dr Robert Haworth has taken this simplification even further in his First Aid for Yachtsmen, reviewed in the summer 1976 issue of THE LIFEBOAT. He has written this book in such a way that a yachtsman with no previous first aid experience can, in an emergency, turn to the appropriate page and follow the instructions point by point.

Specialist in first aid, crew member, HMA, holder of the Institution's silver medal for gallantry, yachtsman, author —and, for Robert Haworth, it all really came about by accident. He is not a native of Barmouth, but comes from an inland town in Lancashire. He was a junior anaesthetist at the Royal Infirmary, Liverpool, when, ten years ago, Dr Gareth Williams, a friend of his university days, invited him to come to Barmouth first as a locum and then to stay and join the practice. His early experience in fact formed most valuable groundwork for the way of life he was to follow, because all the resuscitation procedures and all the ways of dealing with unconscious or very badly injured patients are the everyday work of the anaesthetist.

From the time he arrived at Barmouth Robert Haworth was drawn to the sea and to the lifeboat service. A lifeboat station was established there as far back as 1828. The present lifeboat, The Chieftain, came on station in 1949 and a D class ILB joined her in 1967, just before Dr Haworth came to the town.

Aware of his interest, it was not long before Coxswain Evan Jones, the harbour master, invited the new doctor to go out in the ILB, and then asked him if he would like to train as a crew member. Once in the crew, it seemed only sensible that he should also take over from his senior partner as HMA, and since then his lifeboat activities have given him 'some of the greatest pleasure I have had in practice'.

Unless the presence of a doctor has been specifically requested, when a call comes Robert Haworth hurries down to the waterfront to take his place as an ordinary, dedicated and most enthusiastic member of the crew; perhaps as a deckhand in The Chieftain; sometimes as a crew member of the ILB, sometimes as helmsman. And the experience he gains is invaluable in his duties as HMA. When he is examining a potential crew member, for instance, he knows from personal experience what the man will be up against and he can talk to him about it. He knows that, to take the punishment meted out by an ILB bounding through rough seas at speed, you need to be pretty fit. He knows how severe will be the strain, resulting from exposure, of a four-hour search (the capacity of the ILB) in cold weather.

He has also learnt that what the human frame can stand depends as much upon a man's psychological approach as upon his actual fitness.

' You are out at night in The Chieftain, being thrown about by the boat's movement.

You, in your 30s, realise just how much it must be taking out of crew members in their 50s, perhaps coming up for retirement. But because of their mental attitude, these older men come back apparently the fittest members of the crew.

'During the time I have been in the crew, good leadership has been the highlight of the Barmouth boat. The leadership of Coxswain Jones and Second Coxswain Ken Jeffs has been magnificent, and it is an enormous help to new members. They see how calm the coxswain, second coxswain and more experienced crew members remain and they settle down to be calm in the same way.

'/ think it is important that younger members, even if they are primarily intended to be in the 1LB crew, should go out on service in the big boat occasionally so that they can see how the coxswain and second coxswain handle the boat and how things are done. In Barmouth the same discipline is applied in the ILB as in the conventional boat; people get used to it and enjoy it because they find it is the best way to work.'' When it comes to teaching first aid to lifeboatmen, having been out on service many times himself Robert Haworth understands the difficulties under which his fellow crew members will have to work.

The Chieftain is a super boat, wonderfully seaworthy, but she is a very wet boat with very little cover, and if you've got a couple of casualties on her in bad weather it can be very difficult to practise first aid.

Similarly, it is easy enough to talk about mouth-to-mouth resuscitation on land, but it is a different matter when you have got to do it as the casualty comes over the side of an ILB.

'Being in the crew brings home the point that first aid must be simplified as much as possible. You have got to have people doing the one thing that is essential straight away.' So, Dr Haworth teaches the crew the absolute essentials of first aid and goes over them again and again. All newcomers are given an extensive first aid course and training is continued at sea on almost every lifeboat exercise. Then a first aid course to which the whole crew is invited is held every three years, before the renewal of the first aiders' certificates. Although in an emergency the same people tend to come forward to do first aid while others are involved in boat handling, in fact every one of the crew knows how to do the essential procedures: mouth-to-mouth resuscitation, external cardiac massage, how to stop bleeding from wounds, how to put an unconscious person into the recovery position. Even the coxswain, who would almost certainly be at the wheel of the lifeboat on service, attends the first aid classes regularly.

People in the sea, near drowning, are perhaps the most frequent cases for the lifeboat first aiders of Barmouth. It is usually adventurous eight- or ten-yearolds who get into trouble. Dr Haworth has pulled them out of the water into the ILB, already starting resuscitation, brought them ashore, worked on them in the surgery, travelled with them to hospital and then had the pleasure of seeing them back in Barmouth again two or three days later, the picture of health. That happened once with a little boy found, at the hospital, to have a hole in his heart; he recovered completely.

Dr Haworth remembers one incident in particular, during his own training in boat handling before he became a full member of the crew. He was out in the ILB with Coxswain Jones and another crew member when a call came from the shore to say that a six-year-old child was missing. Within five minutes the coxswain had found the boy floating face downwards well below the water and had gone over the side to get him out.

All the resuscitation procedures were started before the child was entirely in the boat, but without much response.

While the doctor continued his efforts, the other two men got the boy on to the flat deck of a fishing boat, where it was easier to work on the way back to harbour. Eventually, after 20 or 30 minutes, they finally got a response and the child's colour changed.

'You have got to start the procedures immediately the casualty is reached; it's no good waiting until you get to a convenient place. And it may take a long time to get a response and get rid of all the cyanosis of the immersion. The patient may look virtually dead for half an hour, but if you keep trying you can sometimes be successful.' There are, of course, times when Robert Haworth or his partners have been called out because of an accident on a trawler or because it is known that the lifeboat is going out to a near drowning or serious injury. That was what happened on the afternoon of June 21,1971. A message came that a woman had fallen over the cliffs at nearby Friog, dropping more than 80 feet; she was lying badly injured in a small cove cut off by the rising tide. It was not possible to get her up the cliff because of overhang.

The ILB, manned by John Stockford, Colin Pugh and Dr Robert Haworth, launched in force 7 south west winds, backed up by The Chieftain. In very rough seas and heavy swell the ILB, with surf and waves breaking over her, was in grave danger of broaching and capsizing as she twice beached and launched again; first to land the doctor, then to embark the casualty strapped to a stretcher. However, with great skill and determination, and helped by the shore party who waded out shoulder high to steady the boat, the operation was completed successfully. For this service all three members of the ILB crew were awarded the silver medal for gallantry.

The health of the crew, as well as of casualties, is the HMA'S responsibility, and his duties include the examination of prospective new members, a fiveyearly routine check on ILB crew members and checks on conventional lifeboat crew members at specified ages.

He is also responsible for seeing that first aid boxes on the boats and in the boathouses are kept up to date.

During the past ten years Robert Haworth has himself done a good deal of sailing out of Barmouth, both in dinghies and in cruising yachts. Sometimes he acts as navigator for a friend who delivers boats and on one occasion helped him bring a trawler down from Fort William to Barmouth, eventually taking her on to Bembridge, Isle of Wight. So he has sailed the whole of the west coast and part of the Channel.

This summer he is secretary for a new Three Peak Yacht Race; the yachts will race from Barmouth to Fort William, putting into port so that their crews, on the way, can climb the highest mountains in Wales, England and Scotland: Snowdon, Scafell and Ben Nevis.

In just a few years Robert Haworth has become deeply involved in all aspects of seafaring and the lifeboat service as well as in the care of those who come to enjoy the mountains and seashore of this corner of Wales. Can it really be accident that leads the right person to the right place ?—J.D..