Seafarers' Handbook

The information given here is basic, not a replacement for good first-aid training. You are encouraged to get knowledge and practice by taking cardiopulmonary resuscitation (CPR) and first-aid courses when they are offered to you.

First aid is the immediate care given to a person with minor injuries, such as cuts, minor burns, and sprains. It may also be the initial stabilizing treatment given to a person with more serious injuries, such as broken bones.

Reporting medical emergencies and getting medical help are also first-aid functions. The first-aid provider who runs for help is just as important as the first-aid provider who stays with the victim. In an emergency, time is often wasted looking for a phone. Memorize the locations of your ship's phones and intercoms that you can use in an emergency.

Serious injuries require a doctor. Below are examples of injuries and illnesses the require medical treatment from a doctor. excessive bleeding, poisoning, loss of consciousness, severe head injuries, open chest wounds, open abdominal wounds, severe shock, burns covering more than 15 percent of the body, burns on the face, severe allergic reactions, cardiac problems, cardiac arrest, electrical shock, carbon-monoxide poisoning, gas poisoning, smoke inhalation, near-drowning, spinal injuries, broken bones, eye injuries.

When You Are First on the Scene
You may need to rescue the victim from a dangerous situation. Move the victim if he or she is in danger, or have the electric power shut off. Here is the order of actions that you might take in a major emergency:

Victim Not Breathing
If a person is not breathing, you must take action immediately. To perform rescue breathing:

Shock is a condition where an injured person’s vital organs slow down. Shock can happen to anyone who is badly injured, and it is worsened by extreme pain or fright. Here are the signs that a person has gone into shock: Pale or bluish skin, cold to the touch and sometimes clammy, weakness, rapid pulse, increased breathing rate, nausea, vomiting, apathy, unresponsiveness, dilated pupils.

There is nothing a first-aid provider can do to stop shock symptoms once they occur. There are, however, several ways to prevent shock from occurring:

· Control heavy bleeding, often the cause of shock.
· Keep victim lying down.
· Keep victim at a comfortable temperature.
· In cold weather, keep him warm. In hot weather, keep him cool.
· Do your best to comfort, quiet, and soothe the victim.

Immediately apply pressure to the wound that is bleeding heavily. Cut clothing to expose wound. When a clean pad is available, place the pad on the wound and press firmly with your hand. Add extra pads as needed. Do not remove the blood-soaked pads. Wrap the wound with a bandage and elevate the wound if possible. Continue to apply pressure and follow steps for preventing shock.

If you apply direct pressure and elevate the wound and you still cannot control the bleeding, and if the wound is to an arm or leg, then you need to apply pressure at a pressure point. With your hands, press firmly on the major artery supplying blood to the limb that is wounded. Do not apply pressure at a pressure point unless you really need to, and do not stop applying pressure to the wound. Use a tourniquet only as a last resort. Before you use a tourniquet, ask yourself if the situation is bad enough to risk losing a limb. Once a tourniquet is used, it must be removed by a doctor.

All persons who have been bleeding heavily should be seen by a doctor. While you wait for the doctor, keep the person lying down. If the wound was not to the head, elevate the feet. If the wound was to the head, then elevate the head. Keep the victim warm.

Remember to survey the scene. If you can de-energize the circuit locally, do so. Otherwise, use your radio or send someone to de-energize the circuit. Do not leave the victim. Move the victim away from the live circuit as quickly as possible. Do not touch the victim with your bare hands unless the power has been turned off. You may use rubber gloves, pieces of wood, and other nonconductors to try to move the victim away from the live circuit.

If the victim is not breathing after being moved away from the live current, give him or her rescue breaths as soon as possible. Then check for pulse. If there is no pulse, administer CPR.

After breathing and heartbeat are restored, check for other injuries. Keep the victim lying down and warm. Try to maintain a normal body temperature. Treat electrical burns the same way that you treat heat burns.

A stroke is a brain injury. It can be caused by a blood clot entering the brain or it may be caused by a blood vessel rupturing in the brain. The symptoms of a stroke depend on whether the stroke is a minor one or a major one.

The signs of a major stroke are unconsciousness, heavy breathing, paralysis of facial muscles, paralysis of hands or feet, or paralysis on one side of the body.

The signs of a minor stroke are dizziness, headache, pupils of unequal size, blurred vision, sudden failure of memory, change of mood, muscular difficulty, difficulty speaking, or ringing in the ears.

If you believe a person has suffered a major stroke, have the victim lie down, maintain normal body temperature, and get medical help. Do not give the victim anything to eat or drink. Unconscious victims should be rolled on their sides so that fluids can drain from their mouths. Frequently check breathing and pulse.

If you believe a person has suffered a minor stroke, urge him or her to see a doctor. Minor stroke victims often do not want to believe that something is seriously wrong.

Gas poisoning occurs when a person is exposed to a hazardous concentration of gases or vapors. Asphyxia occurs when a person cannot get enough oxygen. Both conditions are life-threatening and should not occur if proper procedures are followed. Never enter a confined space before the atmosphere is tested with two instruments. A toxic-gas instrument that measures the expected gases must show that these gases are not present. An oxygen-deficiency meter must show that the oxygen concentration is at least 19 percent. Seafarers have died when they entered cargo holds that contained hazardous vapors or insufficient oxygen. Very often, the would-be rescuers also died for the same reason. Rescuers frequently believe that they can hold their breath long enough to pull a co-worker to safety. Sadly, that is usually not the case.

Workers who have been overcome in a cargo hold or any other confined space should be pulled into fresh air by a trained rescue team. Your ship should have a team of individuals trained in the use of SCBA (self-contained breathing apparatus) gear, safety harnesses, rescue hoists, and first aid.

Once the victim has been pulled into fresh air, check for breathing. If he or she is not breathing, tip the head back and give two full rescue breaths. Check for pulse. If there is no pulse, begin CPR. Call for medical help.

When working with chemicals, always wear the personal protective equipment (PPE) suggested by the Cargo Information Sheet, Material Safety Data Sheet (MSDS), or product label. Even very hazardous chemicals can be handled safely with the right protective equipment.

Skin Contamination
Put a contaminated person under a shower or hose immediately. Remove clothing while under the shower. Do not, however, pull contaminated clothing over the face. If a shirt cannot be unbuttoned, cut it. Victims have suffered serious eye injuries when they have pulled contaminated clothing over their heads. Wash skin for at least five minutes.

If the chemical was a strong acid or a strong caustic, you might need to use a neutralizing solution. Follow ship procedures for use of these solutions. Do not use such solutions unless you have been trained in their use.

Closely watch the victim. Call for medical help. Take precautions to prevent shock.

Eye Contamination
Immediately flush eyes with water while holding the lids open. This is difficult because victims instinctively close their eyes. You will need to hold the head down in the eyewash and you will need to help the victim hold his eyelids open. If possible, have another co-worker help you. If you do not have an eyewash station, turn the victim's head sideways with the contaminated eye lower than the uncontaminated eye and flush with clean, fresh water. Flush the eyes for 30 minutes. If the injured worker wears contacts, they will need to be removed, but do not waste time trying to remove them immediately. Flush the eyes. Then have the injured worker remove the contacts and then flush some more.

Do not use any neutralizing solution in the eyes. After flushing, cover the eyes with clean eye pads and seek medical help.

Check to see if the victim is conscious and breathing. If the victim is not conscious and not breathing, give two good rescue breaths. Check for pulse. If there is no pulse, perform CPR. If there is a pulse, but no breathing, perform rescue breathing. Call for medical help. If possible, call a poison control center, and follow the instructions given to you over the phone.

If the victim is conscious, try to determine from the victim what poison was ingested or inhaled. If the person cannot speak, look for clues such as smell of breath, burns around the mouth, and labels on nearby cans and bottles.

If there are clues that the poison was a petroleum product or a strong acid or caustic, and the person is not convulsing, encourage the victim to drink one glass of water or milk in small sips. Call for medical help. Keep the victim calm and warm until medical help arrives.

If there are clues that the poison was some other chemical, such as a pesticide, follow the instructions for that product on the Cargo Information Sheet or the Materials Safety Data Sheet. Call for medical help. Keep the person calm until medical help arrives.

If the victim is having convulsions, do not give anything to drink. Lay the victim down. Protect his head by placing pillows and rolled blankets around it. Stay with the victim and check breathing and pulse until medical help arrives.

When the victim is taken to the hospital, bring with you information on the chemical that you believe was ingested. You can bring the Cargo Information Sheet, the Materials Safety Data Sheet, or the product label. This information may be useful to the doctors.

Some signs of food poisoning are nausea, vomiting, chills, diarrhea, and cramps. You should suspect food poisoning if the victim recently consumed food that did not taste right or made others sick. Call for medical help.

If the person is conscious, not vomiting, and is not having trouble swallowing, then you can give milk or water in small sips. This will help dilute the poison. Never induce vomiting unless you are instructed to do so by a poison control center.

There are three major types of food poisoning: botulism, shellfish poisoning, and general food poisoning.

Botulism usually comes from eating smoked meats. Its symptoms are muscle weakness, headache, dizziness, slurred speech, disturbed vision, breathing difficulty, and swallowing difficulty. This person needs a doctor. While waiting for the doctor, keep checking breathing and pulse.

Shellfish poisoning comes from eating contaminated shellfish. Its symptoms are numbness (starting in the face and spreading throughout the body), dizziness, increased salivation, and muscle weakness. This person needs a doctor. While waiting for the doctor, keep checking breathing and pulse.

General food poisoning comes from eating poisonous plants, mushrooms, and berries. Symptoms include nausea, vomiting, cramps, hallucinations, and slurred speech. If the victim vomits, save a sample of the vomit so it can be analyzed by the doctor. If that is not possible, note the color and texture of the vomit so that you can describe it to the doctor. If there is going to be a delay before this person is seen by a doctor, give 30 grams of medicinal charcoal in a glass of water. The victim should sip it slowly. The charcoal will absorb some of the poison and lessen the amount absorbed into the victim's bloodstream. (Only give charcoal for general food poisoning. Do not give it for botulism or shellfish poisoning.)

Broken bones are also called fractures. A simple fracture is a broken bone that does not pierce the skin. A compound fracture is a broken bone that does pierce the skin. The signs of a broken bone are the sound of bone snapping, a bone with a strange or deformed appearance, a bone poking through the skin, or a swollen and discolored area that is painful when touched.

Do not move the victim until the broken bone has been splinted (unless he is near live electrical wires or some other hazard). There are three steps to follow: Stop the bleeding. Splint. Prevent the victim from going into shock.

If clothing is bloody or wet, remove it without moving the injured part of the body. You may need to cut away the wet clothing. If the fracture is a compound one with the bone protruding, do not try to push the bone in. Cover the bone with sterile gauze or clean cloth. If there is heavy bleeding, stop the bleeding by applying pressure. If the fracture is in a finger, hand, arm, foot, leg, or other part of the body that can be immobilized with a splint, use a splint. Keep the injured
area warm by covering it with a blanket or clothing. If the fracture is to a bone that cannot be splinted, such as the shoulder or a rib, have the person lie as quietly as possible. Immobilize and protect the injured area by surrounding the person with pillows, rolled blankets, or rolled towels. Prevent shock.

Dislocations
A dislocation is the movement of a bone end out of a joint. Dislocations usually are caused by falls. Broken bones and dislocations can occur together. The signs of a dislocation are similar to those of a simple fracture. They include swelling, tenderness, deformity, pain, and discoloration. Do not try to move the dislocated bone back into place. Immobilize the injured area, and transport the injured person to a doctor.

Sprains and Strains
A sprain is an injury to a ligament, tendon, or blood vessel. Sprains usually happen when an arm or leg is jerked or moved in a way that is not natural. A strain is an injury to a muscle. When a muscle is strained, it is torn away from the bone or muscle to which it is normally attached. Strains usually happen when a muscle is overworked.

The signs of a sprain are swelling, tenderness, discoloration, and pain when the sprained area is moved. Treat the sprain by immobilizing the sprained area with a splint. Use ice packs to reduce swelling.

The primary sign of a strain is muscle soreness. Back strains are frequently caused by improper lifting. Treatment for a strain is rest and heat. A heating pad or hot moist towels can be used to provide some relief. If the strain is to a back muscle, the victim should lie on his back on a hard surface. Get medical attention for serious strains.

Fainting happens when the brain does not get enough blood for a few minutes. A person who feels faint should either sit down with his head between the knees, or lie down. It is important to try to breathe deeply. A person who faints actually loses consciousness for a moment, recovering almost immediately. After the fainting spells, the victim should lie down and rest for at least 10 minutes. If a victim does not recover from a faint immediately, there is a more serious problem. Call for a doctor. Stay with the victim and keep checking for breathing and pulse.

Burns can be caused by steam leaks, hot oil leaks, hot metal surfaces, the sun, electric shock, and chemicals. The treatment for the burn depends on the burn's depth, size, and location.

The terms first degree, second degree and third degree all describe the depth of a burn. Deep burns damage more tissue and are therefore more serious than shallow burns.

The signs of a shallow first-degree burn are red skin, pain, and swelling. The signs of a second-degree burn are deep red skin with a glossy appearance caused by leaking fluid. There may also be some skin loss and blisters. The sign of a third-degree burn is the loss of all skin layers. There may also be some charring of the skin.

Burns to the hands, feet, face, and genital organs are critical because of their location. Hospitalization is required for such burns.

If a person is unconscious, check breathing and pulse. If necessary, administer CPR.

If the person has received chemical burns, immediately flush the area with water. Follow the instructions detailed earlier for chemical contamination.

Remove clothing and jewelry from the burned area. If clothing sticks to the burn, do not try to remove it. Determine whether the burn is a first-, second-, or third-degree burn. If you are unsure, choose the higher degree. Follow the steps given below for the appropriate degree.

First-Degree Burns
Apply cold, wet cloths to the burned area or immerse the burned area in cold, clean water. Do not use salt water. Keep applying cold, wet cloths or keep immersed in cold water until the pain subsides. Usually this takes 5 to 10 minutes. Either leave the burn uncovered or cover with clean, dry gauze. The skin should heal by itself. If the skin does not heal by itself, seek medical attention.

Second-Degree Burns
Immerse burned area in cold, clean water. Do not use salt water. Keep immersed in cold water for 10 to 15 minutes. Gently dry the area with sterile gauze and cover with gauze. Do not break blisters. If the burn covers a large area, have the person lie flat with legs elevated. Watch for signs of shock. Keep the victim warm. Get medical attention. Second-degree burns require hospitalization when they cover 15 percent of the body or involve one of the four critical body locations (hands, feet, face, genitals).

Third-Degree Burns
Do not immerse third-degree burns in water unless they are chemical burns. With chemical burns, it is important to wash away all the chemical. With all third-degree burns, it is important to prevent infection. Water increases the danger of infection, so it should not be used for cooling. Cover the wound loosely with sterile gauze. Do not wrap the burn tightly (as you would do with a bleeding wound) and do not use tape. Do not use any cloth that might leave lint in the wound. After the burn is loosely covered, you can apply ice packs for cooling, but do not let the dressing get wet. Do not use ice packs if the weight of the packs causes pain. Have the person lie flat with legs elevated. Watch for signs of shock. Keep the victim warm. Get medical attention. One cause of shock for burn victims is loss of fluids. You can give a burn victim water to drink, but do not give fruit juice or alcohol. Third-degree burns always require hospitalization.

1st Degree	2nd Degree	3rd Degree
	(Requires hospitalization for burns to critical areas)	(Always requires hospitalization)
Red skin	Deep red skin with glossy appearance	Lost skin layers
Swelling	Blisters	Charred skin
Cool with water (not salt water)	Cool with water (not salt water)	Do not use water (unless needed to flush out chemical in a chemical burn
Do not bandage	Bandage loosely	Bandage loosely

Heatstroke and heat exhaustion are two forms of heat stress. Watch your co-workers for signs of heat stress, and encourage them to watch for signs of heat stress in you.

Heatstroke is the more severe form of heat stress, and it is an emergency. A person with heatstroke has a very high internal body temperature and has lost the ability to control body temperature by sweating. This person's body temperature is so high that brain damage and death are both possibilities if the person is not cooled quickly. The signs of heatstroke are red or flushed skin that is hot and dry, dizziness, nausea, headache, rapid pulse, and unconsciousness. The body temperature can be as high as 106 F (41 C). You may have noticed that this person was sweating profusely a short time earlier but now is not sweating at all. Cool a heatstroke victim quickly. Soak the person in cool, but not cold water. You can sponge the person with rubbing alcohol or cool water. Do so until his body temperature falls below 102 F (39 C). Then stop the cooling and observe for 10 minutes. If the victim's temperature starts to rise again, start cooling again. Give the victim water to drink. Do not give any coffee, tea, or alcohol.

Heat exhaustion is less serious than heatstroke. The signs of heat exhaustion are fatigue, weakness, and collapse. First aid for heat exhaustion includes moving the victim out of the heat and encouraging the victim to drink lots of water or sports drink, but not alcohol. If the victim's temperature starts to rise, or if there is no improvement in one hour, get medical attention.

Heat cramps are muscle pains and muscle spasms that can occur after working or sweating in the heat. The cramps happen after excessive salt loss and are made worse by drinking too much water. Prevent heat cramps by drinking a sports drink that contains salts or by eating a snack food that contains salt. (Do not eat salty snack foods if you have a heart or kidney problem or have been told by a doctor to restrict your salt intake.)

First aid for heat cramps consists of drinking water that contains table salt. Add one teaspoon of salt to a full glass of water and sip it slowly.

Heatstroke (Requires medical attention)	Heat Exhaustion (requires rest and fluids)
Red or flushed skin	Pale skin
Hot and dry skin	Clammy skin
High body temperature	Body temperature is almost normal
Dizziness, nausea	Headache
No sweating	Lots of sweat
Strong, rapid pulse	Weak pulse
Unconsciousness, grogginess, slurred speech	Heat cramps
Convulsions

Frostbite occurs when exposure to cold weather causes fluids under the skin to freeze. Frostbitten skin looks white or grayish yellow. It also looks pale and glossy. If the victim has lost feeling in the frostbitten part or if it is blue or blistered, the frostbite is severe and requires medical attention. Cover the frostbitten area with clothing or with a blanket and take the victim indoors. If the feet or legs are frostbitten, do not allow the victim to walk. If the hands have feeling and are not shaking violently, give the victim a warm drink, but not coffee, tea, or alcohol. Gradually warm the affected area.

The warming process is frequently painful and the victim may shiver or shake as frostbitten areas warm. Still, it is important to warm the skin quickly. If possible, immerse the frostbitten part in a bowl of warm water. As the skin thaws, it swells and becomes red. Stop the warming when the skin does turn red. Never massage frostbitten skin. Place sterile gauze between frostbitten fingers and toes. Elevate frostbitten parts. Get medical attention quickly for frostbite. The victim should not smoke. Smoking constricts blood vessels in the skin and slows the healing process.

Overexposure to cold weather can cause the following symptoms: shivering, numbness, low body temperature, drowsiness, and muscle weakness. Take a cold-exposure victim indoors. Remove any wet or frozen clothing. Warm cold, numb hands by running them first under cold tap water. Cold tap water is many degrees warmer than the numb skin, so it will feel like hot water. Remove any clothing or jewelry that might interfere with circulation as frozen arms and legs thaw and swell. Give the victim something warm to drink. Do not give alcohol.

An extreme case of overexposure is called hypothermia.The hypothermia victim may be pale or even unconscious. The breathing and pulse will be very weak. Take the hypothermia victim indoors. Bring the body temperature back to normal by wrapping the victim in warm blankets. Do not give any hot drinks until he is fully conscious. Get medical attention quickly.

Not everyone needs the same amount of sleep. Most people need about eight hours of sleep each day. That sleep is most effective when all eight hours are taken at once; two four-hour naps do not equal an eight-hour sleep. STCW 95 (Standards of Training, Certification, and Watchkeeping) recognizes this need for rest. See Chapter 11 for more information on STCW 95.

People who are sleep-deprived are less coordinated and more easily confused than those who have had sufficient sleep. They are also more susceptible to illness because their immune systems are weakened. Learn to recognize signs of fatigue in yourself and in your co-workers.

Fatigue can occur even when a person appears to be getting enough sleep. It can be caused by anemia, thyroid imbalance, or other medical conditions. Encourage anyone who is fatigued all the time to see a doctor.

There are numerous diseases spread by hundreds of kinds of bacteria, viruses, and parasites. We can prevent most of these by reducing our exposure to harmful germs. Four common ways we catch diseases are:

· Consuming contaminated water or contaminated food
· Breathing bacteria and viruses spread in the air
· Being bitten by an insect or animal
· Acquiring a sexually transmitted disease (STD)

There are some simple precautions that you can take to reduce your chances of catching diseases spread in each of the above ways.

There are numerous diseases spread by water and food. The infectious agents are viruses, bacteria, and parasites. When you are in an area where you are not sure whether the food and water are safe, follow these rules:

WHAT TO DO
· Boil local water for five minutes before drinking it, or drink only bottled water.
· Open all bottled water yourself. Do not drink from one that is already open (it may have been filled from a tap).
· Wash your hands, using soap, before you eat.
· Peel all fresh fruits.
· Eat foods that grow with a protective covering such as oranges, bananas, and corn.
· Eat in well-established restaurants.
· Eat hot, well-cooked foods.

WHAT NOT TO DO
· Don't eat raw seafood.
· Don't eat meat that is raw or rare.
· Don't drink unpasteurized milk or eat unpasteurized cheeses.
· Don't drink from a water bottle that has already been opened.
· Don't eat raw foods that cannot be peeled.
· Don't eat foods that require a lot of human handling during their preparation.
· Don't purchase "street food" from small stands or pushcarts.
· Don't put ice cubes in your drinks.

AMEBIASIS
Symptoms: Nausea, diarrhea, weight loss.
Cause: A parasite that can exist in water and in food. The parasite can also be transmitted by sexual contact with an infected person.

ANGIOSTRONGYLIASIS
Symptoms: Severe headaches and stiffness in the neck and back
Cause: A worm-type parasite found in raw or undercooked snails, prawns, fish, and land crabs in Asia and the South Pacific. Lettuce and other leafy vegetables that have come in contact with infected slugs and snails can also be contaminated.

ANISAKIASIS
Symptoms: Sudden severe stomach pain, with nausea and vomiting. Symptoms usually occur within six hours of eating seafood.
Cause: A worm-type parasite found in raw or undercooked seafood.

CHOLERA
Symptoms: Diarrhea, vomiting, and dehydration.
Cause: Vibrio cholerae bacteria found in water and in food.

CRYPTOSPORIDIOSIS
Symptoms: Abdominal cramps and diarrhea.
Cause: Cryptosporidium bacteria found in water and in food. Can be transmitted by close contact with someone who has this illness.

GIARDIASIS
Symptoms: Diarrhea, nausea, vomiting, gas pain, and weight loss.
Cause: Giardia lamblia bacteria found in water, dairy products, fruit, and vegetables.

POLIO
Symptoms: Some people have few or no symptoms. Others have fever, headache, vomiting, severe muscle pain, stiffness of the neck and back, paralysis.
Causes: 1. Exposure to an individual who has been recently infected with polio. The bacteria live in the throat for about a week. 2. Poliomycetium bacteria found in water in regions where sanitary conditions are poor.

TRAVELER'S DIARRHEA
Symptoms: Diarrhea, fever, nausea, vomiting.
Cause: E. Coli bacteria found in water, dairy products, fruit, and vegetables.

TYPHOID FEVER
Symptoms: Sustained fever, headaches, constipation, fatigue.
Cause: Salmonella typhi bacteria found in shellfish, dairy products, fruit, and vegetables.

Take advantage of vaccines that are available for polio, diphtheria, cholera, typhoid fever, and several types of hepatitis.

A few serious diseases are spread through the air. The germs can be bacteria or viruses that float in the air, near someone who is coughing or sneezing. You can avoid catching these diseases by staying away from strangers who appear to have them. During outbreaks of these diseases, avoid congested places such as buses and trains. You can also reduce your risk by washing your hands regularly. You pick up germs by touching surfaces where airborne germs have fallen. Then you infect yourself by rubbing your eyes with contaminated hands, and by handling your food with contaminated hands.

DIPHTHERIA
Symptoms: Sore throat, low-grade fever, swelling in the neck.
Cause: Corynebacterium diphtheriae bacteria spread by contact with fluids from an infected person. You can also get it from handling blankets, towels, and clothing used by an infected person.

MENINGITIS
Symptoms: Intense headache, fever, appetite loss, intolerance to light and sound, stiffness in neck and back, and tightening of hamstring leg muscles.
Cause: Three kinds of bacteria and one virus. It is spread person to person through the air or through close contact.

TUBERCULOSIS (TB)
Symptoms: Persistent cough with sputum or blood, fatigue, weight loss, fever, night sweats.
Cause: TB bacteria spreads through the air from person to person. Generally, you have to be close to a TB-infected person for a long time to become infected. There is a difference between being infected with TB and having TB. Most people have defense systems that fight the TB bacteria by producing antibodies. Only about 10 percent of infected people develop TB disease.

Some of our most feared diseases are carried by mosquitoes. Luckily, only a tiny portion of mosquitoes are infected with viruses and transmit diseases to humans. Most mosquitoes are annoying, but not harmful. Mosquitoes breed in standing water. Mosquitoes feed in the early morning and again in the late afternoon and evening. During these periods, wear insect repellent, or at least wear long sleeves and long pants.

WHAT TO DO
· Get vaccinations.
· Use mosquito netting over your bed.
· Use insect repellent, one that contains DEET= diethytoluamide (N,N-diethyl-m-toluamide).
· Wear long pants and long sleeves when mosquitoes are numerous and feeding.

WHAT NOT TO DO
· Don't leave standing water around where mosquitoes could breed and multiply.

DENGUE FEVER
Dengue fever is a viral illness spread by aedes mosquitoes. It is found primarily in tropical Asia, Africa, and the Caribbean. Dengue fever is treated with bed rest and medications for pain and fever. Dengue fever is a disease that you can catch more than once. Sometimes the second case is much worse than the first, and is called dengue hemorrhagic fever. Dengue hemorrhagic fever is a very serious illness in which the patient has abnormal bleeding and very low blood pressure.

MALARIA
Malaria is caused by a virus carried by the anopheles family of mosquitoes. The virus infects a patient's red blood cells and causes fever, chills, muscle aches, and headaches. The malaria patient usually has several cycles of fever, each followed by chills. There are four kinds of malaria, only one of which is life-threatening. The correct medical treatment depends on the malaria type. Anyone who experiences malaria symptoms following travel in a malaria zone should see a doctor immediately. Malaria can be treated, and a complete cure is possible if the medical treatment is started right away. Two of the malaria viruses can lie dormant for long periods of time yet cause a relapse of the disease up to four years later.

The medications that can be taken to prevent malaria have side effects, and they need to be taken regularly (before, during, and after exposure) in order to be effective. The most common side effects are nausea, vomiting, diarrhea, and dizziness. In some regions, the malaria viruses are resistant to some of the preventive medicines. The medications are recommended for use only in high-risk malaria areas during the wet season; the risk of infection during the dry season is small. The malaria risk is also smaller in urban areas than in rural areas.

YELLOW FEVER
Yellow fever is caused by a virus carried by the Aedes aegypti mosquito. This disease causes a high fever with chills, muscle aches, headache, and vomiting. Victims may appear to recover and then become more ill. In the more serious stage of the illness there may be bleeding, jaundice, and kidney failure. There is an effective vaccination for yellow fever.

There are more than 20 disease-causing microbes that can be spread by sexual contact. Diseases spread by sexual contact are called sexually transmitted diseases (STDs).

To absolutely prevent STDs, you can abstain from sex or be monogamous with someone who is not infected. Being monogamous means you have sex only with your lifetime partner, and your partner has sex only with you.

All STDs have an incubation period during which people are hosts to dangerous microbes. They can transmit diseases to other people, but they have no disease symptoms themselves. This means that you cannot tell who might be carrying a dangerous disease. To minimize your chances of acquiring STDs, use latex condoms. Condoms provide significant protection from many bacterial infections.

If you experience any STD symptoms, get prompt medical attention. Most STDs are treatable. If left untreated, some can cause very, very severe illnesses, including cancer, liver disease, and blindness. At the present time, there is no cure for HIV infections. HIV causes AIDS (acquired immunodeficiency syndrome) which can result in premature death. Early medical treatment for HIV can improve health and prolong life, so it should be sought.

AIDS/HIV
Symptoms: There might be no symptoms for years. Earliest symptoms are persistent swollen glands and chronic infections.
Incubation period: years
Cause: HIV virus is spread by: 1.Vaginal, oral, or anal sexual contact with infected person. 2. Contaminated needles used for drugs, tattooing, and body piercing.
Comments: HIV is a disease with many stages. During the early stages, which can last years, there typically are no symptoms. The final stage of this illness is AIDS. HIV illnesses have been reported in 160 countries. There is no cure at this time.

CHANCROID
Symptoms: Chancre sores
Incubation period: 2-14 days
Cause: Bacterial infection
Comments: Chancroid chancres are not as firm as syphilis chancres (see below).

CHLAMYDIA
Symptoms: Abnormal genital discharge; painful urination; pain in testes during sex, for men; pain in lower abdomen during sex, for women.
Incubation period: 1-3 weeks
Cause: Bacterial infection spread through direct contact with secretions in genitals, mouth, and throat.
Comments: Can be cured with antibiotics.

CRAB LICE
Symptoms: Itching; visible lice and lice eggs in pubic hair.
Comments: Can be treated with anti-lice treatments.

GENITAL HERPES
Symptoms: Blister-like sores, mild itching, and burning. The sores will heal and be gone for months, but they return.
Incubation period: 2-20 days
Cause: Viral infection spread by skin-to-skin contact.
Comments: There is no complete cure, but medication relieves symptoms and reduces the number of repeat outbreaks.

GRANULOMA INGUINALE
Symptoms: Lumps or blisters in the genital area. Blisters slowly enlarge into sores.
Incubation period: 8-80 days
Cause: Bacterial infection spread through sexual contact.
Comments: This disease is common in the tropics and subtropics. It can be treated with antibiotics.

HEPATITIS B
Symptoms: Fever, headache, muscle ache, fatigue, appetite loss, vomiting, darkened urine, yellow eyes, diarrhea.
Cause: Viral infection spread through sexual contact, through the sharing of hypodermic needles, and by unsanitary body piercing and tattooing.
Comments: A vaccine is available. This virus is able to penetrate "natural" condoms; use latex condoms.

PAPILLOMAVIRUS
Symptoms: Painless, fleshy warts on genitals, anus, and throat. If left untreated, it can cause cancers of the cervix, penis, and anus.
Cause: Viral infection spread through sexual contact.

SYPHILIS
Symptoms: Painless open sore in the genital area called a chancre. Later symptoms include a skin rash that begins on hands and feet. If left untreated, bacteria can damage heart, eyes, brain, spinal cord, bones, and joints.
Incubation period: 10 days to 3 months
Cause: Direct contact with the chancre on an infected person.
Comments: Can be treated with antibiotics.

TRICHOMONIASIS
Symptoms: Painful urination. If left untreated, it can lead to inflammation of bladder or urethra.
Incubation period: 4-20 days
Cause: Parasite is spread through sexual contact.
Comments: Treatment is available.

DIPHTHERIA
Symptoms: Sore throat, low-grade fever, swelling in the neck
Cause: Corynebacterium Diphtheriae bacteria spread by contact with fluids from an infected person. You can also get it from handling blankets, towels, and clothing used by an infected person.

MENINGITIS
Symptoms: Intense headache, fever, appetite loss, intolerance to light and sound, stiffness in neck and back, and tightening of hamstring leg muscles
Cause: Three kinds of bacteria and one virus. It is spread person to person through the air or through close contact.

TUBERCULOSIS (TB)
Symptoms: Persistent cough with sputum or blood, fatigue, weight loss, fever, night sweats Cause: TB bacteria spreads through the air from person to person. Generally, you have to be close to a TB-infected person for a long time to become infected. There is a difference between being infected with TB and having TB. Most people have defense systems that fight the TB bacteria by producing antibodies. Only about 10 percent of infected people develop TB disease.

Epidemiology Fact Sheet, a list of contagious diseases, their causes, symptoms, and steps that can be taken to avoid contracting and/or spreading diseases. (Hawaii Department of Health Communicable Disease Division):
http://www.hawaii.gov/health/resource/comm_dis/factsheet.html

United States Centers for Disease Control and Prevention: Diseases, Health Risks, Prevention Guidelines, and Strategies
http://www.cdc.gov/travel/

The Nicos J. Vardinoyannis
Seafarers' Handbook

First Aid

The Nicos J. Vardinoyannis Seafarers' Handbook

First Aid

The Nicos J. Vardinoyannis
Seafarers' Handbook