With a competitive offshore race successfully completed, a rested crew hops on the boat, now kitted out with the delivery mainsail and a roller-furling jib, and heads for the boat’s homeport. A beautiful westerly breeze fills in and the crew raises the main and prepares to unfurl the jib. Just as a crewmember uncleats the furling line, a strong puff hits the starboard beam. The jib violently unfurls with a loud snap, and that’s when you see that your crewmate’s index finger has gotten sucked into the fairlead.

This is a real example of the kind of medical situation that happens to even experienced sailors all the time and the kind of thing that crews have to know how to handle. 

A sailboat is an island: You and the crew have your own language, your own rules, you have your own boat culture. Getting everyone back to the dock safely is the biggest responsibility you have. But sometimes thing don’t go to plan. Are you prepared for a medical emergency?

First responses and key decisions

When dealing with any medical situation, first check your own pulse before checking the patient’s. If emotions are running high, take three deep breaths to calm yourself. This advice was given to me in my training and is something I tell all my students. You need to be as collected and clear-minded, as best you can, to make good decisions. Next, know your limitations and the limitations of your crew and vessel. Is this something you can deal with?

Know when and how to get help

There are many health emergencies that sailors may contend with, but there are two that stand out as requiring rapid identification and direct professional medical treatment. Stroke and heart attack demand quick diagnosis and fast medical help to ensure the best outcomes. 

Stroke

Slurred speech, facial drooping or weakness on one side of the body are some signs of a stroke. If you have any intuition that someone is having a stroke, you need to get them off the boat as soon as you can. Don’t delay. Medical professionals use the phrase, “Time is brain.” Call for help, immediately, by any means at your disposal and do what you need to do to get the victim to professional medical help as soon as possible. 

Heart attack

The classic symptom of a heart attack is chest pain that feels like a heavy pressure on the chest. This pain may radiate down the arm or up into the neck and jaw. This is another example of a true medical emergency where getting the crewmember to medical professionals as fast as possible is best. Consider giving the victim a couple of baby aspirin to chew and swallow. Monitor their symptoms and check their vital signs. Treat shock by laying the victim down and razing their legs 20 degrees. If needed, perform CPR.    

Making the call to head in or notify the Coast Guard can be difficult. If you’re undecided or don’t know what to do, get on channel 16 and ask for help directly. If they are in radio range, the Coast Guard is always monitoring this channel and can connect you with medical personnel. Other vessels may also be able to provide help by relaying your messages or in other ways. You never know, the chief of surgery or trauma surgery may be on the water and hear the call and can help provide assistance. Understand how to use your VHF radio and other communication devices, such as satellite phones, satellite messengers and even some smartphones equipped with SOS satellite services. In these cases, act fast and act decisively.

Fortunately, most medical situations on a boat are not life threatening, and can be initially treated while at sea. Having a basic understanding of how you can treat some of the more common medical conditions on a sailboat, can help you and your crew manage these situations.

Lacerations and abrasions

Stop the bleeding. Hold direct pressure on the wound, if possible, above the level of heart until the bleeding has stopped. To clean the wound, good old soap and clean water work best, and then evaluate the severity. Wound closure adhesive strips work great for holding wounds together.

However, if the wound is large enough that it causes tension when you bring the skin edges together, stitches may be needed. Apply a clean dressing and reinforce as needed. Keeping the wound dry and clean is important to prevent infection.

Burns

Remove any clothing or debris from the burn, unless it is adhered to the skin. Irrigate the wound with clean water and evaluate the severity. Do not use cold water or ice as it can cool the core body temperature down too much.  Place a clean dressing on the wound. Consider pain medication, topical triple antibiotic ointment, and oral hydration depending on severity. Keeping the wound dry and clean is important to prevent infection. If you see muscle, tendons, or bones this is a Class 4 burn and a medical emergency, and you need to get the crewmember off the boat as soon as possible.

Fingers

Broken or dislocated fingers can be managed with simple splinting and buddy taping to the adjacent digit. If you can see bone or if there is an amputation, get the victim to medical professionals as soon as possible. Place the amputated digit in a clean, dry bag, and keep it cold.

In the case of the sailor who got their finger sucked into the fairlead, the crew quickly identified that this was a medical emergency beyond the capacity of the crew. The Coast Guard was contacted and the sailor was medically evacuated by Coast Guard boat. The crewmember received immediate medical attention, and today has made a full recovery with all of their fingers.

Seasickness

Seasickness can happen to anyone, even seasoned sailors. If you know that you are prone to seasickness using Scopolamine patches or taking Meclizine ahead of your voyage is key. However, seasickness can sneak up and hit you unexpectedly. Consider things like ginger chews, other hard candy, or acupressure bands. The goal is to avoid severe dehydration.  

Dehydration

Maintenance hydration with water and electrolyte replacement is the mainstay of treatment. If your urine is dark and concentrated you need to drink more fluids. Everyone aboard should encourage each other to stay hydrated. Headache, lightheadedness and cramping are all signs of dehydration. If a dehydrated crewmember’s mental status changes, or they are unable to drink fluids, they are likely dehydrated to the point where they need IV fluids and you should get them to medical professionals. 

Heat related illnesses

Prevention is the first line treatment. Minimize UV exposure and encourage maintenance hydration. Reduce the core body temperature if elevated. Normal body temperature is 98.6 degrees Fahrenheit. If a heat-stressed crewmember’s temperature is noticeable elevated, take measures to cool them.  Remove the crewmember’s clothing, spray them with water and apply cold compresses to his or her neck, armpits and groin. Monitor them for mental status changes.

Hypothermia

A core body temperature less than 95 degrees Fahrenheit or 35 degrees Celsius is hypothermia, which is common in particular after a man overboard incident. Remove the victim’s wet clothing and put on warm, dry clothes. Lay the victim down and wrap them in a blanket or survival blanket. Monitor their symptoms and check their vital signs. If possible, warm the cabin or apply hand warmers on their neck, armpits and groins 

Allergic reactions

Most allergic reactions are not anaphylaxis. If someone is having an allergic reaction give them an H1 antihistamine like Diphenhydramine, or an H2 blocker. Swelling particularly of the neck, face and tongue and difficulty breathing are signs of potential anaphylaxis. If anaphylaxis is suspected and an epinephrine auto-injector is available, use it immediately. Keep their head and chest elevated, and the victim in a seated position. Monitor their breathing and get them to medical professionals rapidly.

Recommendations 

When leaving on any voyage, being prepared for a medical situation is essential. Certifications in CPR and basic life support are the cornerstone when dealing with medical emergencies. Other certifications like Safety at Sea are crucial for any boating emergency. 

Read your first aid manual and understand it before you have an emergency. Be familiar with what is in your first aid kit and check it often, as items tend to disappear on boats. Make sure you have an adequate amount of supplies and that nothing is expired. The crew should know where the first aid kit is stored, understand its content, and be prepared to perform whatever role is needed during an emergency. 

Store bought first aid kits are a good starting place, but should be supplemented. Items to consider adding to your kit if not already included:

• Pain management: Aspirin, Ibuprofen, Acetaminophen, topical numbing spray

• Bug bites/itching: Antihistamines, hydrocortisone cream 

• Gut: H2 blockers or proton pump inhibitors, antacids

• Dressings: Triple antibiotic cream, wound closure adhesive strips, waterproof bandages 

• Seasickness: Acupressure bands, Meclizine, Scopolamine patches  

• Dehydration: Electrolyte tablets

• UV: Sunscreen and aloe lotion

• Other items: Nitrile gloves, alcohol wipes, splinting material, ace wrap, survival blanket, instant cold packs, hand warmers, bandage scissors, disposable scalpel, tweezers, thermometer  

Remember to remain calm if a medical situation develops on your boat. Clear, rational, decisions lead to good outcomes. Most medical conditions are not immediately life threatening. Know your own limitations and the limitations of the boat and crew. If you are unsure of what to do, reach out, help is around you. Understand how to use your communication devices before the emergency. Check your first aid kit and be familiar with what is in it. Lastly, enjoy the sail. You cannot anticipate everything that can, and will go wrong on a sailboat. How you prepare and respond to these challenges makes all the difference.