LITTLE DID I THINK some 20 years ago when I started in general practice that I should be in active service for more than a decade as a lifeboat doctor or HMA (honorary medical adviser), as we are called. Years later I asked the now retired mechanic, who was out with me, about my first trip. Most of the crew at that time were the old 'Dick Evans', double gold medal crew of the Moelfre lifeboat. The trip had been what has become more commonplace for me since: transferring in a near gale from the lifeboat to a Jacob's ladder on the cargo vessel that was four or five miles offshore to examine the patient before he was brought ashore. I asked Ifan Owen, 'What would have happened if 1 had fallen off thai night? Would you have found me? Would you have been able to see me?' 'Not at all,' he said. And of course after that I went through a period of wondering whether it was a good idea for a family man to continue as a lifeboat doctor, and I almost resigned.

Since then I have become more philosophical and consider it no more than a part of my normal practice duties that extend a few miles offshore, and that is what it is. Having the opportunity of being a lifeboat doctor depends very much on your choice of location for your general practice, and living by the sea one has a special responsibility. I have been very fortunate in always having a crew in whose hands I felt completely safe at all times and a coxswain on whom I could rely, so that when he said 'jump', I jumped. Normally the HMA is required only in fairly good weather, and a force seven or eight gale would be about the worst, with a bit of luck.

As chairman of the lifeboat station committee I am involved in local lifeboat affairs and running the station. I teach the crew first aid, examine new crew members, and re-examine the present crew for both boats at regular intervals. A medical newsletter is circulated by the RNLI, edited by Dr Geoffrey Hale, and there are regular meetings at the BASICS (British Association for Immediate Care) annual conference at which the chairman of the Medical and Survival Committee, Professor Sir George Smart, is present. The 200 HMAs are members of BASICS as an immediate care scheme and I am at present organising training sessions up and down the country.Merchant ships and swimmers Our lifeboat station is near the shipping lanes to and from Liverpool, and Moelfre Bay is one of the best places to shelter from a gale on the west coast.

Calls come at any time of the year, but there is a difference between those in summer and winter. In winter the medical calls are specifically to merchant ships in the bay, while in summer most work is in rescuing small boats and swimmers in distress, either using the big boat, the 37ft 6in Rother class lifeboat Horace Clarkson, or more often the small inflatable D class lifeboat with an outboard motor to rescue children who have floated out on mattresses, for instance. These are the rescues that bring in the victims of drowning or apparent drowning. Tragically, these are often holidaymakers or daytrippers.

I like to make a link with the relations of the victim if possible for counselling.

The medical calls can be as varied as those in ordinary general practice.

Often the crisis is that the ship is bound for foreign waters and that any time wasted ashore or anchored in the bay is time lost by the company; therefore the sick person has to be got ashore as quickly as possible. The person may be suffering from a coronary with chest pains, abdominal pain precipitated by the celebrations of the last night ashore, an accident on a tanker or fishing vessel, and even a gynaeological condition in the wife of a crew member. In these cases the lifeboat may act just like an ambulance for what is called a medical evacuation, but often the person has to be examined while aboard and the condition stabilised before taking him ashore. It is therefore wise for the lifeboat HMA to have a fair idea of what type of cases he might be called to treat and to carry a special bag at all times with fresh supplies of equipment which may be needed.

A modern lifeboat, unless it is one of the large ones, is just not equipped to treat sick persons on board. Our particular lifeboat, the Rother, has accommodation if necessary for 37 survivors, but in the forward cabin where I usually work there is room at most for only two stretcher cases in very cramped conditions.

The stretcher is invariably the most versatile of all—the Neill Robertson model. We can sometimes sling another one or two on the deck. In fact last year we treated a cardiac arrest on deck on top of the cabin for the threemile journey from the Liverpool-to- Dublin car ferry back to the slipway.

Sometimes Anglesey Radio, the General Post Office radio station, will ask me to speak to the skipper of a merchant ship maybe 100 miles away who is approaching our area asking for medical advice. This past autumn I treated the captain of a Royal Navy mine sweeper who was brought ashore by his own boat to my local beach 200 yards from my surgery. The Post Office radio station is apparently directed to ask for medical advice from the nearest hospital.

This sometimes causes difficulties, and the classic case is of the junior houseman in hospital asking the skipper to bring the patient ashore so that he can be seen in outpatients next morning! When a vessel approaches our patch. Angelsey Radio has agreed to ask me for advice. Being lifeboat doctor is most rewarding work and in essence there may not be the slightest bit of difference from one's patients ringing up during surgery time for advice, for this is the responsibility one has in general practice—to provide primary care.

Rescues Rescues are entirely in the charge of the area coastguard rescue headquarters, in our case Holyhead. They may ask for the assistance of a helicopter from the RAF Search and Rescue Squadron 22 at Valley. Once the coastguard thinks that it is necessary to launch the lifeboat, he or she (we have lady coastguards) will inform the honorary secretary of the lifeboat station who will authorise launching. I will have been given the relevant information already and possibly discussed the pa-tient with the ship's captain. If I am in the surgery it will take me only a few minutes to go down to the lifeboat station; otherwise I can be informed by radio in my car. It will then take only a few minutes to slip on my boots and an extra jumper and, putting my flasher on top of my car and sometimes using my siren, judiciously, to approach the boathouse. I have my personal RNLI protective clothing and lifejacket hanging in the boathouse and wear crashhelmet- type headgear. I always receive every courtesy from the crew, and the head launcher or one of the shore crew, who are such a very essential part of any 'General Practitioner on the lifeboat' was first published in the British Medical Journal, Volume 282, May 30, 1981, and is reproduced here by kind permission of the editor.

lifeboat station, take charge of my ignition key until the boat is retrieved.

If the weather is easterly it can be difficult, and until our new breakwater is built we have to shelter in the Menai Straits and we are off station for some hours.

The coastguard will have also informed the ambulance station to stand by and an ambulance will be waiting for us when we return to the slipway. I always find the launch down our slipway particularly exciting: it is quite a steep one, one of the steepest in the country.

I think everybody who does emergency work secretly enjoys that little extra perk of the thrill of the job—in my case to be involved in an exhilarating launch.

Once at sea everyone knows his place and I just keep out of everybody's way.

I think in this respect that there is some similarity between the lifeboat HMA and the ship's surgeon in the Royal Navy. It has been said, 'Like the engineer, the surgeon had a long battle before his status as a naval officer was recognised".

The view of the sea surgeon, which— unchanging as the sea—still holds today, is a blend of acceptance and rejection, of a claim to dictate the methods while commanding the surgeon's services.

Dismissed as a man taking no part in the life on the ship, he is accorded the guarded welcome of the stranger within the gates. Once one gets to know the crew, however, and has the good nature to haul on a line here and there and keep out of the way during launching and retrieval, one is treated with the greatest of good nature and one has great affection for one's boat..