First Aid at Sea

The Offshore Medical Reality

Offshore sailing places medical emergencies in a context that shoreside first aid training doesn't address: the nearest hospital may be 12–48 hours away. A Coast Guard helicopter has a typical unrefuelled range of 150–200nm. Beyond that, evacuation requires a ship diversion or fixed-wing aircraft with a parachute medic — measured in hours, not minutes.

This means the crew must be capable of: controlling bleeding and preventing infection for hours or days; managing a fracture through rough water; treating hypothermia in the raft or below decks; keeping an unconscious crew member alive until they can be handed to professional care.

The offshore first aid kit minimum:

- Wound care: sterile dressings, bandages, triangular bandage, wound closure strips, skin staples, irrigation syringe, antiseptic solution, gloves

- Pain relief: over-the-counter (ibuprofen, paracetamol) plus prescription opioid analgesic for serious injury (with appropriate advice from a physician)

- Infection control: broad-spectrum antibiotic course (amoxicillin or similar, prescribed)

- Immobilisation: SAM splint (moldable aluminium splint for any fracture)

- Cardiac and airway: CPR face shield, automated external defibrillator (AED) for extended offshore passages

- Thermal: space blankets (minimum one per crew)

- Miscellaneous: dental emergency kit (temporary filling, tooth pain relief), seasickness medication, eye wash, scissors

Telemedicine: Register with DAN (Divers Alert Network), MedAire, or an equivalent offshore medical consultation service before departure. With a satellite phone or SSB radio, you can have a physician guide you through treatment decisions at any time. This changes the calculus from 'what can I do alone' to 'what can I do with expert guidance.'

Hypothermia

Hypothermia — a drop in core body temperature below 35°C — is the leading cause of death in cold-water and life raft survival situations. It can occur faster than most sailors expect: in 10°C water, a person without immersion protection may become incapacitated within 30 minutes.

The stages:

- Mild (35–32°C): Uncontrollable shivering, confusion, slurred speech, loss of fine motor control. The person is still conscious and shivering.

- Moderate (32–28°C): Shivering stops (an ominous sign — the body can no longer generate heat this way); muscle rigidity; severe confusion or unconsciousness; cardiac arrhythmia risk increases dramatically.

- Severe (below 28°C): Unconscious, no visible shivering, pulse may be absent or very faint. Ventricular fibrillation can occur with minimal physical disturbance.

Treatment:

Remove the person from cold and wind. Remove wet clothing (the evaporative cooling from wet clothing is significant). Wrap in space blankets and sleeping bags. Apply warmth to the core — armpits, chest, groin — not the extremities. Provide warm sweet drinks if fully conscious and can swallow safely. Evacuate by horizontal transfer — sudden positional changes can trigger cardiac arrest in moderate-to-severe hypothermia.

What not to do: Do not rub the extremities — peripheral vasodilation returns cold blood to the core and drops the core temperature further. Do not give alcohol — it dilates peripheral blood vessels with the same effect. Do not allow the person to walk or exert themselves — the effort redirects blood to muscles and away from the core.

Trauma and Common Injuries at Sea

Boats are mechanically violent environments. Winch handles, boom gybes, blocks under load, falls on wet decks, and sea state combine to produce a range of injuries that must be managed aboard.

Lacerations: The most common injury. Most sailing lacerations are significant — a winch handle at speed, a block, or a shroud under load produces deep cuts. Control bleeding with direct pressure — hold for a minimum of 10 minutes before checking. Irrigate the wound with clean water (use the irrigation syringe). Close with wound closure strips (Steri-Strips) or skin staples. Deeper wounds may require sutures — if trained, proceed. If not, closure strips and time.

Fractures: Immobilise with a SAM splint and padding. The SAM splint can be shaped to any limb or the ankle. A lower leg fracture is manageable — the person needs to be off the injured limb but can be accommodated below. An arm fracture affects sail-handling capability. A suspected spinal fracture requires treating the person as spine-injured until ruled out by medical personnel.

Head injury: After any fall that involves a head impact, monitor for concussion: headache, confusion, nausea, unequal pupils, difficulty balancing. Mild concussion — rest, no exertion, monitor. Any loss of consciousness, worsening headache, vomiting, or deteriorating level of consciousness is a serious head injury — call for medical advice immediately.

Burns: Cool immediately with running water for 20 minutes. Do not apply ice, butter, or any cream. Cover with a clean non-adhesive dressing. Burns from galley fires (hot oil, flame) or fire aboard are typically partial or full thickness — requires medical care ashore as soon as possible.

Seasickness: Debilitating in a genuine storm, preventing crew from performing watch duties. Address proactively: medication before sailing (scopolamine patch, promethazine, ondansetron). A crew member who is severely seasick and cannot keep fluids down for 12+ hours requires assessment for dehydration — oral rehydration salts if conscious; IV fluids in extremis (if trained and equipped).

CPR and Cardiac Emergencies

Cardiac arrest on a boat is a genuine offshore scenario — and the response in the first 5 minutes determines survival. With no EMS, the crew is the cardiac team.

Compression-only CPR: For adult cardiac arrest, current guidance supports compression-only CPR as effective as CPR with rescue breaths for trained bystanders with no equipment. 30 compressions at a rate of 100–120 per minute, hard and fast (5–6cm depth), allowing full chest recoil between compressions.

Hypothermic cardiac arrest: In cold-water cardiac arrest, the cold brain is significantly more resistant to anoxic damage. Continue CPR much longer than in a normothermic patient — up to 60 minutes is appropriate for hypothermic cardiac arrest before stopping. The phrase in wilderness medicine is 'not dead until warm and dead.'

AED (Automated External Defibrillator): For extended offshore passages, an AED is worthwhile. Most AEDs are designed for use by untrained bystanders — they speak instructions aloud and determine whether a shock is appropriate. Attach the pads, follow the instructions. Ventricular fibrillation (the most common shockable rhythm in cardiac arrest) can be reversed by early defibrillation.

Practical CPR on a moving boat: Kneeling on a moving deck during CPR is physically demanding. Brace your own body and use your full body weight rather than just arm strength. Rotate compressors every 2 minutes to maintain quality — effective compressions require significant effort.

Calling MAYDAY for a cardiac emergency: Call MAYDAY on Channel 16 immediately for any cardiac arrest. The Coast Guard can coordinate emergency medical advice by radio and may be able to direct the nearest vessel with medical capability to your position. Every minute the call is made earlier is a minute closer to professional care.