Paramedics reflect on incredible container ship rescue

On 2 March, during yet another dreadful deluge, Flight CCP Prue Snedden and ACPs Brad Stokes and Joshua Lee were called out to a critically ill worker on a container ship stationed off the Sunshine Coast.

Normally based at Archerfield, Prue was on transfer at the Sunshine Coast and was working night shift when the call came through just after 8.30pm.

The weather was too dangerous for a helicopter winch, so Prue, along with a flight doctor, geared up and boarded a police vessel to follow paramedics Brad and Joshua to perform a difficult and dramatic overnight rescue from the container ship during this major weather event.

Prue said the first report from the QAS about *Mehir (not his real name), detailed he’d been unwell for two to three weeks but was being treated for a shoulder wound for the last fortnight before their callout.

"He had apparently received a medical consult from Italy and later a telehealth session with a Melbourne-based doctor, but all container ships were unable to dock because of the flooding and were instead sitting out in the channel off Maroochydore, so he’d been unable to get to shore for further checks and treatment,” she said.

“The QAS had contacted the water police anticipating the weather conditions were too rough for the helicopter unit.

“Initially the plan was for both teams to attend via the police boat, but, due to time to scene, the ACP crew was sent out first as they arrived at the water police depot quickly and had a plan to attempt to retrieve the patient and return to rendezvous with the medical team at the water police depot.”

“Out on the bay the conditions were abysmal – it was bucketing rain and the water was very rough, so getting onto the ship itself was a challenge.

“On arriving at the boat and boarding, it was obvious there would be delays in getting the patient off, and the deckhands’ descriptions of the patient indicated he was in a critical condition.

“Josh and Brad boarded and sent the Police boat back to retrieve us to bring more critical resources to the patient.

“Brad and Josh really made the first steps in getting to the patient safely and gave an amazing situation report which set the scene for the whole case.”

The pair faced a critically ill patient with a Glasgow Coma Scale (GCS) of 8, a severely infected, fungating wound on his shoulder and “dark coffee grounds” vomit near his bedside, suggestive of a possible gastrointestinal bleed.

“Despite the challenging conditions, everyone – especially the crew – wanted Mehir off the ship, so Brad and Joshua gave him fluids and an antiemetic in preparation for his extrication.

“From his clinical presentation, vital sign survey and brief ‘interpreted’ clinical history, it was obvious he had severe sepsis and was acidotic with fatiguing respiratory compensation.

“When Mehir was strapped into a Robinson Stretcher ready for highlining to the rescue boat, Brad rang me to discuss the logistics and that he wasn’t sure he liked them,” Prue said.

The combination of dangerous conditions, no flotation and Mehir’s rapidly deteriorating condition from that restrictive stretcher thwarted their attempts to transfer him, so Prue boarded the container ship to join the ACPs to care for him.

By the time Prue arrived on the container ship’s deck which was only minutes after getting off the phone, the patient had progressed into cardiac arrest.

Brad and Joshua had repositioned him, removed the restrictive stretcher the crew had applied, placed a Laryngeal mask airway (LMA) and were performing CPR on him.

Further care included a single adrenaline bolus and treating reversible causes, which the team had identified as sepsis, acidosis and respiratory restriction and fatigue.

“Mehir was in arrest for no more than 10 minutes before they got his pulse back,” Prue said.

“Post ROSC they continued to focus on oxygenation and ventilation until he started to self-ventilate, improve in his GCS and enable removal of his LMA.”

Prue and the ACPs then pulled together their “Plan B”, which meant managing the patient until morning on board the ship, as there was no way off with the patient in this state.

“Before I arrived Brad and Joshua had been resuscitating Mehir with a very helpful, non-English speaking crew standing around them, which was a little intimidating,” Prue said.

“Brad and Joshua stabilised Mehir and coordinated the crew to move him an enormous 600m to the other end of the top deck in the pouring rain to the first aid room, as we’d decided this was the best place to continue his treatment until morning.

“Overnight Brad and Josh did almost all of the clinical intervention, while I was concentrating on the logistics and worked the phones to see what we could do,” Prue said.

Their main challenge was to ensure their equipment and supplies lasted until help arrived the next morning.

The team created a makeshift ICU and Mehir slowly started to improve –meanwhile the weather had worsened and the police vessel along with the doctor on board had to return to port.

“Firstly, we needed to ensure we had enough oxygen – a big tank – to last until help arrived as one of the oxygen cylinders had fallen overboard earlier in the night,” Prue said.

Mehir was placed on an adrenaline infusion and given IV antibiotics, and Prue was able to get more of his medical history from his managers.

They told Prue he’d had three weeks of infection from a large shoulder wound –a staph infection – and conjunctivitis.

He had received oral antibiotics and was due to be reviewed in Brisbane by a medical team for further care.

“We made up a fluid solution for him and then warmed him up and changed his clothes which were not only wet but also soiled,” Prue said.

“We then took stock and started planning – we had six hours of power left on our monitor, 12 hours on our syringe driver, and placed him on a fluids regime in consideration of what we had on board and the risks of fluid overload.

“Knowing we had a minimum six-hour wait until a helicopter could winch him out, we checked his blood pressure and pulse manually so we could conserve equipment power for a time when we might really need it.”

Prue said Mehir improved over the next four hours … but it wasn’t to last.

“His antibiotics (Ceftriaxone) had been working and he’d improved to a GCS 13, but then at around 5am, he started decompensating,” she said.

“The severe sepsis and acidosis meant his body had used all its reserves and had nothing left – so he needed to be ventilated and intubated – impossible for us to do as we didn’t have the equipment or medication to do it safely or efficiently.

“I then contacted RSQ (the lead agency) as we believed Mehir was going into respiratory failure.”

Meanwhile RSQ had been working to coordinate a team to remove Mehir from the ship, but they’d hit some snags - the weather was still too unsafe for a helicopter winch, and they needed winch-certified staff as Prue’s fatigued state ruled her out of being safe to winch.

A third plan was hatched, and the police vessel was reactivated with a fresh team sent out in it with new batteries and oxygen supplies with a helicopter to follow.

As the team had anticipated, Mehir had a seizure at 6am and went into cardiac arrest, his second in their care, but the team intubated him and was able to get his ROSC back using adrenaline within minutes.

“We then worked out a strategy to keep him alive while the poor weather continued to delay the fresh RSQ team’s arrival,” Prue said.

“So from 6am until 9.40am we had to hand-ventilate him and his adrenaline had to continue and because he was being ventilated, he had to be next to an oxygen tank.

“We then had to make the big journey with him still intubated and ventilated to the other end of the ship where the HELO extrication zone had been identified.

“There was rain and water everywhere and by this stage we only had enough oxygen to last him another 30 mins while we waited for the Helicopter team to arrive.

“There were further delays and we had to continue to bunker down and bring resources to the extrication zone to continue care.”

Prue said when the fresh team arrived by the Helicopter just after 9.40am, she and the ACPs had never been so excited to see them.

“Compto (Anthony Compton) and Rick Harvey, the rescue crewmen brought bloods and monitoring equipment with them. Overnight Mehir’s belly had become increasingly distended, and he’d gone very pale – validating our initial diagnosis of a potential gastrointestinal haemorrhaging,” she said.

Kawana Station graduate paramedic Josh was in his fourth week out on the road when he and his senior partner Brad were called to the Mooloolaba wharf to get to the container ship.

Despite having had a few different careers before becoming a paramedic, this job on the eve of his 29th birthday was one he says will stay in his mind for a very long time.

“We left at around 10pm after electing to go out to the ship first because of the weatherrelated despatch delays with the flight crew,” Josh said.

“I have never been out on a boat in that type of situation, and I was a bit excited as I knew this wasn’t a typical job and there was certainly a bit of risk in it which also had to be taken into account.”

That risk started with boarding the container ship when the team was met with a rope ladder with planks, combined with a 1-2 metre swell and heavy rain.

“It was a bit daunting as you had to time your move with the peak of the wave to get onto the ladder, so you weren’t knocked off by the boat as it lifted again with the next wave,” Josh said.

“You didn’t want to end up between the two boats in pitch black water.”

Josh said the language barriers which came with the non-English speaking crew also complicated their efforts at times.

But for Josh, this job provided a precious opportunity for him to develop critical lifesaving skills so early in his career.

“I believe this was my first cardiac arrest, so, managing such a sick patient on top of his arrests; being able to ventilate him and putting in an LMA, doing compressions, putting in intravenous lines and do all the other assessments, as well as coordinating with Brad to get Prue our CCP on board and work out the best way of extrication – this is just gold for a junior ACP as there was so much involved both clinically and logistically,” Josh said.

As for his learnings, Josh said being on top of his primary and secondary assessments while studying and then being able to apply them and really get on top of them ensured he gained a strong understanding of what was going on with a patient.

“It was huge for me to be able to become familiar with the critically ill patient assessments,” he said.

“From a more clinical perspective, it was good to learn the importance of timeliness and communication, for example, Mehir was so sick he was difficult to canulate, and we urgently needed to get fluids into him and a canular into veins at the same time someone’s running iv lines ready for action, so being aware of who’s doing what in a short time span, communicating priorities and who’s doing what was an essential learning.

“The greatest highlight to me came afterwards, considering all the things we did for this man who’d gone into cardiac arrest twice, seeing how sick he was and the time we spent with him unconscious being hand-ventilated before being winched out and flown to ICU at hospital and then learning he’d been discharged later – that was such a huge highlight for me.”

“I don’t believe he would have survived another hour if we hadn’t got to him when we did, he was so critical even by then.”

With 19 years of paramedic experience behind him, Josh’s senior partner and ACPII Brad Stokes agreed this was a once-in-a-lifetime job for all involved.

“At the time it was just a case, but a few days later when I had a chance to reflect on what we did, it was so far outside the norm,” Brad said.

“Even the way the job started, because boarding the ship was going to be fairly challenging, I felt it wiser to take only what was necessary and leave the extra equipment on the boat ready for the return trip with the patient.

“But the combination of the poor weather, the language barriers and our patient’s deteriorating condition and our limited supplies saw us having to work around so many obstacles for much longer than we anticipated.

“Even the next morning the weather was so bad, when we were preparing our patient for airlifting, we weren’t just dealing with heavy rain and rough seas, there were literally waterfalls coming off the sides of the stacked containers.”

But Brad said teaming up with a fresh graduate in Josh, particularly while they waited for Prue to arrive certainly wasn’t one of those challenges.

“Josh was very good – he’s quite a knowledgeable young man,” he said.

“Some graduates are lucky to get the (learning) opportunity straight after their degrees and he was quite easy to manage and understood what needed

to be done and everything flowed really well.

“But we certainly had many long hours on our knees and crouching on the deck next to our patient, having to do things manually for hours to conserve our battery supplies, coming up with workarounds and using even the boat’s medical supplies to keep him alive and that was a huge learning curve.”

Brad said on reflection, Mehir’s survival was remarkable.

“He was so sick, and he arrested twice – it’s crazy to think he survived this,” he said.

“I went home the next morning thinking how sad it was to see a man so far away from the comforts of his family and his home, who had clearly been working very hard for a very long time to provide for his family.

“It was quite exhilarating to know he would see his loved ones again – I feel so happy for his family too knowing he’ll be returning to them.

“It’s just great to know our hard work paid off – it really was something movies are made of.”

Pru, Brad, Josh and Anthony’s outstanding work saw them win the Working Together category in this year’s QBank Everyday Hero Awards held in October.

Scan the QR code to view the LifeFlight footage of the helicopter rescue.