Cruising

Medical Mariner

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Last spring, I was snorkeling near Sandy Spit in the BVI, entranced by the fish meandering through the coral heads. My snorkeling buddy gestured enthusiastically at a particularly bright betafish and together we zoomed to it like moths to a flame, unaware that it was headed for shallow water. Suddenly, a wave crashed over us, and we realized we were in trouble. Wave followed wave, and before we knew it up was down and we were being tossed around like pinballs in a box of coral heads.

We managed to swim back to deeper water, where our friends met us with the dinghy. They were both certified in Wilderness First Aid and hauled us out with great confidence that dissolved into horror as they saw just how bloodied we were. Over the course of an hour, they methodically tended to our wounds using the first aid kit onboard our TMM Yacht Charters boat, which fortunately was stocked with everything they needed.

I still carry those scars, and they serve as a reminder that even the most benign aspects of sailing can end in injury, and that a well-stocked first aid kit is a critical piece of equipment.

SICK AT SEA

My coral mishap is just one in a galaxy of calamities one might suffer while sailing. In a study on the subject, Dr. Andrew Nathanson of Rhode Island Hospital determined that sailors suffer a rate of 4.6 injuries for every 1,000 days spent sailing on a keelboat. He surveyed 1,881 sailors, and of the 1,715 injuries they reported, the majority were cuts, bruises, sprains and contusions caused by tripping or falling; being hit by a boom, spinnaker pole, sail clew or other crewmember; or handling running rigging. Most injuries occurred while changing sails, operating a winch or tacking and gybing. Heavy weather was a contributing factor in nearly a quarter of all injuries. The most common illness was seasickness, followed by dehydration and hypothermia.

In other words, as any sailor knows, it’s relatively easy to suffer a minor injury or illness while sailing. It’s also easy for these minor problems to become major ones if they aren’t treated properly. My coral injuries were cleaned and dressed thoroughly, but without sufficient medical equipment on board, along with the knowledge to use it, they could easily have become infected.

It’s also important to remember that it can be challenging to administer care at sea. Access to onshore medical assistance is limited, and the space available for storing medical supplies and providing care is restricted. These unique challenges make it all the more important that you be prepared to administer first aid before you set sail.

GET EDUCATED

It would require several articles to describe all you need to know to perform first aid on a sailboat. It’s therefore wise to have at least one—preferably two—people on board who are certified in first aid techniques, including resuscitation and basic treatment of injuries, hypothermia and near-drowning.

Just as you would never take a sailboat out until you learned how to sail it, you should never try to use a first aid kit unless you know what you’re doing. Otherwise, you can end up doing more harm than good. As Dr. Stuart Miller, an emergency room physician in New Jersey who has written extensively on marine medicine, puts it: “Without basic medical knowledge as well as a tincture of common sense, a medical kit is simply a loaded gun.”

The responsibility for adequate first aid treatment on board falls primarily on the skipper, but it’s not a burden he or she should carry alone. After all, who will take charge if the skipper is impaired? For that reason, current ISAF Offshore Special Regulations require that one or two crewmembers (Category 2 and 1 respectively) hold a “Senior First Aid Certificate.” In the United States, you can become certified through courses offered by the American Heart Association, The American Red Cross, The American Safety and Health Institute or the National Safety Council. The classes last several days and certify you for two to three years. Many sailors take a Wilderness First Responder course for in-depth training.

GET EQUIPPED

Once you’re properly trained in how to use a first aid kit, you’ll be ready to select or assemble one for your boat. Dr. Michael Jacobs, an internist on Martha’s Vineyard, has spent years developing a line of Adventure Medical Kits configured specifically for sailors. These can be used for everything from daysails to ocean voyages and can be purchased at adventuremedicalkits.com.

When you’re putting together a medical kit for your own boat, Dr. Jacobs recommends you tailor it to the type of sailing you do. First consider how many crew will be on board and for how long. This helps determine the quantity of medications and supplies you need. Will you be sailing in coastal waters or offshore? While sailing near shore, you can expect to be in contact with medical professionals via cell phone or VHF radio, and your medical kit should contain supplies that can stabilize a crewmember or initiate treatment until shore-based medical assistance is available—usually in less than 12-24 hours.

You’ll need sunscreen, Aloe Vera and ibuprofen for sunburns; antiseptic cream, waterproof tape, gauze pads and waterproof bandages for dressing wounds; vinegar and cortisone cream for jellyfish stings; and hospital-quality tweezers to remove debris from contaminated wounds. You should also have an assortment of over-the-counter medications for treating maladies such as diarrhea, seasickness and indigestion.

If you’re cruising offshore, your link to medical assistance will be via SSB radio or sat phone, and you’ll need to be able to provide extended medical care for more than 24 hours. An offshore medical kit should include supplies for treating burns, cuts and lacerations, as well as sprains and broken bones. In addition to what you find in a good coastal kit, you’ll need triangular bandages, cold packs, slings and splints for fractures; skin staples or wound closure strips for large wounds; and a variety of prescription medications including painkillers and antibiotics.

Many marine physicians, including Drs. Jacobs and Miller, suggest packing an additional crew first aid kit, a smaller version of the main kit that crew can access for basic supplies at any time. This will keep the supplies in the main kit intact, organized and protected. A crew kit should include the most commonly used items, such as waterproof adhesive bandages, antiseptic wipes, antibiotic ointment, seasickness pills, sunscreen, Aloe Vera and ibuprofen.

Whatever the situation, Dr. Jacobs says that “the most important component of a kit may well be a means of reliable communications.” If you can contact medical assistance and communicate in a helpful manner, you can then learn how to stabilize or even cure your crewmate. You might also include A Comprehensive Guide to Marine Medicine, coauthored by Dr. Jacobs as a quick reference for treating virtually any medical problem at sea.


GET ORGANIZED

Once you’ve selected the contents of your kit, it’s time to pack it up. Label all parts and group supplies together based on what they’re used for. Dr. Jacobs’s Marine 1000 Adventure Medical Kit divides supplies into color-coded bags containing different categories of supplies, including CPR instruments, medications, fractures and sprains, burns, wound care and bleeding. Each is zipped up in a watertight plastic-and-canvas bag, then packed in a nylon flotation case sealed with water-resistant zippers. Each bag includes an index card describing its contents and how to use them, a feature that can help minimize feelings of panic during an emergency. When assembling a homemade kit, Ziploc bags packed within watertight Pelican boxes will work well to keep your supplies dry.

Keep your kit in an easy-to-find location with a flashlight stored nearby. Once a year, inspect the contents for expiration dates, inventory and general wear and tear. For extended trips, keep a prescription list in a watertight container with the boat’s papers. This should document every crewmember’s current prescription medications (including dosage and frequency), allergies and significant medical history. You never know when this information may come in handy.


GET GOING

In addition to his general study on sailing injuries, Dr. Nathanson, in collaboration with Dr. Edwin Fischer, recently conducted a post-race survey of the injuries and illnesses suffered aboard every boat completing the Newport-Bermuda Race between 1998 and 2006. The rate of injury or illness for the 8,105 participants was only 12 in 1,000, with four radio consultations and three hospital evacuations in the course of five races.

Why was there such a relatively low rate of injury in a major ocean race that pushes sailors to their mental and physical limit? Perhaps it’s the emphasis placed on safety and preparation, which translates into skippers and crew who are better prepared to both prevent and cope with medical issues aboard.

It takes time and effort to equip your boat with medical supplies and acquire the knowledge you need to prevent, assess and treat illnesses and injuries at sea. Once you do, however, you’ll sail easier knowing you are able to keep your crew safe and happy. As Jacobs says, “If sailors spent as much time caring for their bodies and maintaining their systems as they do caring for their sails and maintaining their boat’s systems, we’d all be much better off.”

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