JANUARY 2013 • ON THE JOB
As a health officer on the Canadian coast guard Ship Sir Wilfrid Laurier, Theresa McGuire provided primary care, counselling, health and safety promotion and emergency treatment for the ship’s crew and passengers
“Let me give you a hand with that.” A crew member was helping a passenger fasten his life-jacket and adjust his helicopter seatbelt. I was impressed with the keen observation skills and offer of assistance to a newbie like me, before the ocean voyage had even started.
On Aug.7, we had arrived in Kugluktuk, Nunavut, and were being shuttled by helicopter to the Canadian coast guard Ship Sir Wilfrid Laurier, anchored in the harbour nearby. For the next six weeks, I would be a health officer aboard the Laurier, travelling through the Northwest Passage, far north of the Arctic Circle’s 66 degrees latitude. I was feeling apprehensive, in spite of going through a three-month screening process and completing a four-day orientation, conducted by the coast guard’s national health officer program coordinator.
I am comfortable working in unusual environments and working independently; I am an occupational health nurse with Health Canada and a former army nurse. My clients, who include coast guard crews in the Atlantic region, work in high-risk occupations. It was a crew member who suggested I “come aboard” on one of the Arctic voyages. I wanted to know more about the challenges of this work environment and knew that I had the required qualifications for a position as a health officer: a background in community health, advanced practice skills and experience in primary care nursing in remote areas.
Once we lost sight of land, I went through a hatch door to investigate my workplace. The sight of a brand-new Stryker stretcher, an automated external defibrillator, oxygen and Entonox therapy cylinders and an abundance of IV, suture, and dressing supplies was reassuring. I knew then that I could handle all but major surgery quite independently. A full burn-dressing kit, hypothermia kit, mass casualty triage kit, a basic supply of pharmaceuticals and access to an onboard helicopter and experienced pilot for medevac completed the picture.
The First Nations and Inuit Health Branch Clinical Practice Guidelines for Nurses in Primary Care was a trusted resource,and I could reach a medical consult service on the satellite phone. All coast guard crew are certified in emergency first aid; three are designated as rescue specialists while on board and have advanced medical treatment training. We did additional training together to practise and enhance their skills.
After about a week, my sea legs kicked in and I began to feel comfortable in my new environment. Fortunately, the Laurier is a stable ship, and there were few cases of seasickness. I needed to be aware of existing medical conditions, and I met with each crew member and passenger to conduct a confidential health survey and brief physical assessment. Cardiac, diabetic and neurological emergencies can occur suddenly and necessitate critical evacuations.
My sick bay hours were 8 a.m. to 4 p.m., seven days a week. At all other times, I was on standby to be “piped” for emergencies. I quickly got to know crew members and earned their trust as I started assessing and treating infections and minor injuries. It warmed my heart when someone would say, “We’re glad you’re here.” A small metal particle embedded in an eye proved to be one of the most serious of my challenges. The patient was in significant pain and distress. If not resolved quickly, an eye injury can mean medical evacuation. After numbing the eye, I used every gentle procedure at my disposal, along with calm hands and reassuring words, to help me remove the particle.
A few weeks into the voyage, archeological divers with Parks Canada joined the Laurier to search for the ill-fated Franklin expedition ships. I reviewed emergency medical treatment procedures with them; the nearest hyperbaric chamber is many hours away, even by helicopter or charter plane. Fortunately for me, the divers were well trained and safety conscious.
The Arctic Ocean, as beautiful as it is at this time of year, can be deathly cold and unpredictable. Having a well-prepared, self-sufficient team is critical, and the coast guard certainly practises what it preaches when it comes to marine safety and emergency response. Briefed by an experienced ship safety officer, all newcomers receive instruction regarding fire stations, lifeboats, abandon-ship drills and full immersion suits. Life-jackets are inspected and maintained regularly and are always worn when boarding and when travelling in Zodiacs and survey vessels. Steady in hand, foot and eye, the Laurier crew are respectful of the challenge of working on a moving platform. It was a relief to see everyone safely back on board each night, after long days spent surveying on open water, flying in the helicopter, climbing remote beacons and placing large buoys. Of course, we were always ready for search and rescue calls, which could range from other vessels in distress to downed aircraft.
There were no critical emergencies on my leg of the voyage. However, medical evacuations took place on other coast guard ships over the summer. There are usually six ships underway in the Arctic during this season (July through October), in various areas throughout the North.
The amazing level of cleanliness onboard rivalled that of any hospital I had worked in. We took additional sanitation measures when a rogue upper respiratory virus appeared early on in the voyage. Disinfectant wipe down of all common areas and increased handwashing soon stalled the spread. Later on in the voyage, and with my captive audience in mind, I put together information sessions on positive coping strategies for shift work, blood pressure and blood sugar monitoring, back safety and hearing protection.
Life on board was often fun, even when the seas and weather were rough. The weekly menus on the Laurier were varied and well balanced. Barbecues were held on the aft deck to mark the arrival of visitors, a rotation of captains and the end of our voyage. After hours, we took turns calling bingo, organizing card games and playing music. Our hydrographers and archeologists gave presentations on their fascinating work. CBC’s The National was documenting these research activities, and we gathered in the lounge to watch clips from the show on satellite TV. Basic e-mail service meant that I could keep in touch with family and friends. For me, the day’s best entertainment was the breathtaking sunset from high on the bridge. I never tired of watching the multitude of ways that waves can shimmer and reflect light.
On trips ashore, I met community health nurses in the Inuit communities of Cambridge Bay, Taloyoak and Gjoa Haven, to discuss the resources we had available to us. Making connections with nursing colleagues was essential — I might have needed local help, and any of them might have required disaster response assistance from me or the Laurier. When I met students at a high school in Cambridge Bay, I encouraged them to consider the coast guard and nursing as career options.
This assignment at sea was a time of reflection and learning and an opportunity to validate my values and knowledge. I would highly recommend the experience to any nurse seeking an out-of-the-ordinary challenge.
THERESA McGUIRE, RN, DOHN, COHN(C), CRSP, IS AN OCCUPATIONAL HEALTH NURSE WITH HEALTH CANADA, IN HALIFAX.