Canapes are going out to the aft deck and a four-year-old has helped himself from the tray. Ten seconds later he is on his feet, silent, hands at his throat, eyes wide with a look you will never forget. He is not making any noise. That silence is the emergency.
Choking
A partly blocked airway is noisy: coughing, wheezing, distress. A completely blocked airway is silent, and it is immediately life-threatening.
- What to look for: sudden onset while eating or playing with a small object; hands at the throat; inability to speak, cry or cough; colour changing; panic then collapse.
- What you do FIRST: shout for help, raise the alarm, send someone for the trained responder and the bridge. Stay with the child.
- What this course will not do: it will not teach you back blows, chest thrusts or abdominal thrusts. The techniques differ by age, they are physical, and done wrongly they injure a child. They are taught and assessed hands-on by an approved provider. Nothing you read on a screen makes you competent to do them.
Anaphylaxis
A severe allergic reaction that can develop within minutes of exposure to a food, a sting or a medicine.
| Look for | Note |
|---|---|
| Swelling of lips, tongue, face, throat | Airway is closing |
| Widespread rash or hives | Often, but not always, present |
| Wheeze, noisy breathing, hoarse voice | Breathing compromised |
| Sudden pallor, floppiness, collapse | Circulation failing |
What you do FIRST: shout, raise the alarm, get the trained responder, and get the child own prescribed auto-injector and the parents. Anaphylaxis is a bridge-and-captain event: telemedical advice and probable evacuation. The child needs a hospital even if they improve.
Asthma
Many children onboard have asthma. Look for breathlessness, wheeze, an inability to complete a sentence, or a child going quiet and using their shoulders to breathe. What you do FIRST: get their own reliever inhaler and the parents, keep the child sitting upright and calm, raise the alarm, and get telemedical advice early. A silent chest in a struggling child is deterioration, not improvement.
The Common Thread
All three are airway and breathing emergencies. All three can go from mild to critical in minutes. In all three, your first act is the same: shout, alarm, bridge, trained responder, parents and their medication. And in all three, the treatment itself belongs to somebody who has been assessed on a real course.
Onboard Notes
- Know before service which guests carry an auto-injector or inhaler, and exactly where it is kept.
- Grapes, nuts, olives, cherry tomatoes and boat toys with small parts are choking hazards.
- Silence in a distressed child is the worst sound on the boat.
- Preparatory study only. Awareness, not first aid training. This course teaches no techniques and does not qualify you to treat a child. A current, practically assessed paediatric first aid certificate from an approved provider is required.