This article describes the conception, implementation, and evaluation of a wilderness medicine-based first aid class for the commercial fishing industry. Commercial fishing is a dangerous occupation in the United States. Currently, commercial fishermen often only have access to basic first aid classes. Because of its focus on austere environments, hazardous conditions, and distance from definitive medical care-hallmarks of commercial fisheries-wilderness medicine offers a more appropriate approach to decreasing morbidity and mortality in the industry. A 2-d, 16-h pilot wilderness medicine course for commercial fishermen, Fishermen First Aid and Safety Training (FFAST), conducted for Dungeness crab fishermen, was effective and well received, based on pre- and postcourse knowledge, skill, and attitude surveys. FFAST has been approved by the Coast Guard and is being made more widely available to commercial fishermen in the Pacific Northwest. The FFAST program offers an example of how wilderness medicine can improve safety and emergency medical response for a wide variety of austere environments not traditionally linked to the backcountry.

BACKGROUNDCommercial fishing is a hazardous occupation in the United States (US). Injury surveillance data relies heavily on US Coast Guard reports, which capture injuries severe enough to require reporting. The reports do not incorporate the fishermen's perspective on contributing factors to injuries and staying safe while fishing.MATERIALS AND METHODSWe conducted a pre-season survey of Dungeness crab fishermen during 2015 to 2016. Community researchers administered surveys to fishermen. Respondents reported their opinions about factors contributing to injuries and staying safe, which were grouped into similar themes by consen- sus. Descriptive statistics were calculated to explore the number of injuries, crew position, age, and years of experience. Chi-square tests compared perceptions of injury causation, staying safe, and other factors.RESULTSFour hundred twenty-six surveys were completed. Injury causation perceptions were sorted into 17 categories, and staying safe perceptions were sorted into 13 categories. The most frequently cited causes of injury were heavy workload (86, 21.9%), poor mental focus (78, 19.9%), and inexperience (56, 14.3%). The most frequently cited factors in staying safe while fishing were awareness (142, 36.1%), good and well-maintained fishing gear/vessel (41, 10.4%), and best marine practices (39, 9.9%). Opinions were not significantly associated with experiencing an injury in the past while fishing, but some opinions were significantly associated with crew position, age, and years of experience.CONCLUSIONSThe perceptions of fishermen can be evaluated further and incorporated into training or intervention development. The fishermen-led approach of this project lends itself to developing injury pre- vention strategies that are effective, realistic and suitable. The resources available at FLIPPresources.org, such as informational sheets for new fishermen, sample crew agreements, and first aid kit resources, supply workers in this fishery with real solutions for issues they identified through their survey responses.

Objectives: Non-fatal injuries in the high risk US Dungeness crab fishery have been under-documented, despite their potential for lost work time and income, long-term disability, and early unwanted retirement. The Fishermen Led Injury Prevention Program (FLIPP) characterized injuries in this fishery, in order to identify work hazards and inform injury control measures.Methods: The FLIPP injury survey was completed by 426 fishermen in 23 Washington, Oregon, and California fishing ports prior to the 2015-2016 Dungeness crab season; 413 (97%) provided injury information for this analysis. Participants indicated whether they had been injured in the previous 12 months, described the injury, any treatments received, and whether the injury limited their ability to work.Results: Participants were mostly male (98%), more than half (56.6%) worked as deckhands, and reported considerable fishing experience (median = 14 years, interquartile range 5-27). Eighty-nine fishermen (21.5%) reported an injury incident in the past year, of which 49 (55.1%) were limiting. The 89 incidents yielded 102 injuries, of which nearly two-thirds were sprains/strains (23, 22.5%), surface wounds/bruises (17, 15.0%), cuts (18, 17.6%), or punctures (11, 10.8%). More severe injuries, including eight fractures, were rare. The majority of injuries received either no treatment (27, 26.5%) or first aid (35, 34.3%); clinical care was less common (22, 21.6%), and emergency care rare (3, 2.9%).Conclusion: One in five Dungeness crab fishermen reported an injury incident in the previous year. Most injuries were not severe and did not result in clinical care, but approximately half were work-limiting. Control measures must account for the remote and resource-limited workplace in commercial fishing.

Introduction The West Coast Dungeness crab fishery is high-risk for occupational fatalities. The Fishermen Led Injury Prevention Program (FLIPP) explored this worker population's nonfatal injuries and safety perspectives. Methods Focus groups were held along the West Coast to (a) review reported injuries, (b) discuss risk factors, and (c) identify content to inform future FLIPP research activities, including survey development. Focus group data were transcribed and analyzed qualitatively. The FLIPP survey was pilot tested with groups of fishermen before broad distribution. Results Nineteen fishermen participated in focus groups and 21 pilot tested the FLIPP survey. These discussions illuminated injury risk perceptions, crews' current safety provisions, and what survey items would be relevant for fishermen. Conclusion To engage fishermen in the process of identifying and developing injury prevention efforts, focus groups, and pilot testing were effective methods for incorporating their ideas into a survey.

Acknowledgments This project could not have been completed without the hard work of many individuals. Capt. Perry York of Oregon State University was instrumental in safe and successful ROV operations at Cape Perpetua and Siletz aboard the R/V Elakha. provided assistance with ROV field work. Apologies and thanks to the crew of the F/V MadDog, Captain Blane Steinmetz and Jose Ubina, for " weathering " our attempts at late season field work at Orford Reef. Supreme thanks to George Becker of the F/V Moxie, for saving the drifting Phantom from an otherwise grim fate. We are grateful to all eyes, ears, and hands in Port Orford who helped bring it ashore. ROV sampling protocols are in an ongoing evolution with tremendous insight and encouragement provided

❑ Trainings limited to 20 fishermen • Topic areas: CPR, injury prevention, assessment, wounds and burns, orthopedic injuries, altered mental status, environmental injuries/ illnesses, drowning, cardiorespiratory emergencies, and patient handling • Integrated commercial crab fishermen-specific scenarios for hands-on training • Participants completed a Preand Post first aid knowledge questionnaire • Participants evaluated training, including: whether they would recommend the training, usefulness and effectiveness, suggestions for future RESULTS • Complete data on preand post-class knowledge was provided by 20 Astoria fishermen and 17 Newport fishermen