Tips for Safer Sailing and Preparation for Medical Challenges at Sea
Whether you are a racer, cruiser, or day sailor, you need to be prepared for various medical challenges at sea, ranging from minor injuries to full-blown emergencies. Even a small cut on a finger or toe can become a liability if not properly treated. Other common occurrences on the water, such as heat exhaustion and hypothermia, can quickly escalate to life-threatening emergencies if timely action is not taken.
I recently spoke with Dr. Bill White, a retired emergency physician and avid sailor. Bill is also a volunteer coach for the US Naval Academy (USNA) offshore sailing team, and a member of the Cruising Club of America (CCA). He has participated in nine races to Bermuda and multiple passages to and from the Caribbean. He is currently planning a transatlantic crossing with the CCA this summer. At the time of our conversation, Bill was preparing for the MTAM Safety at Sea (S@S) seminars where he will deliver a lecture on offshore medical care.
While S@S seminars are required for crew participating in most offshore races, many Bay sailors and cruisers have found their lectures and hands-on classes to be invaluable. Even the S@S virtual seminars are excellent alternatives for sailors who want to improve their knowledge.
In addition to taking classes, I asked Bill for recommendations based on his extensive medical experiences both on and off the water.
Medical Supplies
All boaters should have medical supplies onboard that are appropriate for expected crew members, anticipated duration, and distance from shore-based assistance. Commercial marine kits are readily available and should be supplemented with easy-to-understand books that can give additional guidance, including when to call for professional assistance.
Some boaters augment commercial kits with additional supplies and ask their primary physician to prescribe medications such as antibiotics for use when offshore.
“However, having a robust medical kit isn’t helpful if you don’t know how to use its contents appropriately,” cautions Bill. “There are a variety of antibiotics that are used to treat different infections, and using the wrong one can create more problems than it solves.”
In addition to bringing enough personal medication for the passage duration, Bill advises that crew should carry information regarding their personal medical history, including current medications and pertinent allergies. This is especially prudent for extended passages or when out of range of professional services. If confidentiality is a concern, crew can simply prepare a sealed envelope that is only opened if needed.
Training and Assistance
Bill and I both agree that sailors should be trained in CPR and first aid. While there are many local training options, I prefer classes offered by the Chesapeake Area Professional Captains Association (CAPCA) because they are taught by boaters with additional content specific to challenges at sea.
To address concerns about handling onboard medical emergencies, Bill recommends Maritime Medical Access (MMA), a telemedical service available through George Washington University Department of Emergency Medicine. MMA provides 24/7 on-call physician support to vessels at sea, including private yachts. Costs are quite reasonable and are based on size of vessel, number of crew, passage duration, and location. They utilize almost any form of communication including texting.
Most Common Incidents
When asked about the most common incidents at sea, Bill mentioned a 2010 study that examined 1226 sailing-related injuries and their causes. The findings cited crew maneuvers and adverse weather conditions as top contributors to onboard injuries. The most common cause of head injury on a boat is getting hit by the boom. Boom related injuries accounted for 80 percent of deaths. Other serious injuries include burns from spilled or sloshed hot liquids in the galley. Wearing foulies while cooking can help prevent burns, but an additional layer of protection should be worn beneath since hot water can sometimes melt foulies and complicate burn injuries.
Injuries
Most of the common injuries on a sailboat tend to occur on exposed body parts, such as fingers, hands, and toes. Lacerations must be thoroughly cleaned before applying an appropriate dressing and securing with a bandage or gauze wrapping. Since sailors are in a wet environment, Bill suggests buying waterproof Nexcare bandages to protect wounds from contamination. He also prefers using a syringe for high-pressure irrigation and carrying bottled water for wound cleaning, since boat tank water can be tainted.
If injuries to limbs require splinting, Bill recommends Sam splints which are lightweight, moldable, and easily form-fitted to body areas. Even if your boat isn’t venturing offshore, splints can provide temporary relief and protection from further injury if a crew member experiences a sprain or break before returning to the dock.
Hypothermia
When exposed to cold temperatures due to wind, water, precipitation, or air, your body loses heat faster than it can produce it. Prolonged exposure will eventually result in an abnormally low body temperature or hypothermia. Hypothermia affects coordination, cognitive function, and strength. This impacts not only the afflicted crew member, but it also burdens others who must care for the afflicted and assume their duties. In severe cases, hypothermia can progress to becoming life threatening.
We can avoid hypothermia by wearing layers of proper clothing, staying dry, and by keeping well hydrated and nourished.
Bill advises “The key to preventing hypothermia includes recognizing it early and understanding the stages. Someone may be cold-stressed but not yet hypothermic with a body temperature approaching 95 degrees Fahrenheit. Shivering occurs at this stage, but normal mental function and coordination can be maintained. Early stages of hypothermia occur between 90- 95 degrees core body temperature, where crew may act confused, stumble, slur speech, and have pronounced shivering. It’s important to intervene immediately by rewarming them. This can be especially challenging as sailors are often in a cold and wet environment.”
Rewarming actions require relocating the crew member to a warmer and dryer location, removing wet clothing, applying dry layers of clothes, wrapping them in blankets, and providing fluids and nutrition.
Sun Exposure
Sunburn and heat exhaustion are frequent challenges for sailors, especially racers who often don’t have biminis to provide cover. Seeking the shade of sails, staying hydrated, reapplying sunscreen, and wearing high-tech long sleeve shirts with hoodies are all helpful in avoiding heat-related illnesses. Similar to hypothermia, confusion and loss of consciousness can result if symptoms aren’t addressed early. Prevention is the key to avoiding exposure-related illnesses.
Seasickness
Everyone gets seasick. I used to say “I never get seasick” until it happened to me. At the time, I was one of six sailing from Bermuda to Newport and developed symptoms shortly after departure. Initially, I refused medication due to side-effect concerns. After one miserable day I took Dramamine and was back to normal within hours. I never missed a watch and now empathize with others who battle seasickness.
Bill had a few stories to share about treating seasickness on various voyages: “All medication has side effects. Some can cause dilated pupils, difficulty urinating, and even hallucinations, all of which are problematic on a boat. If you see crew getting confused or acting weirdly, ask if they are taking seasickness medication. One solution may be to stop taking it and reassess. Most people adapt to being offshore within a day or two. In my case, I initially apply a scopolamine patch (Transderm Scop) and remove it after three days.”
One advantage of the patch is that it doesn’t require swallowing and therefore can be effective even if someone is already vomiting. Suppositories are another non-oral solution. When asked about Stugeron, which is popular among some sailors though unavailable in the USA, Bill mentioned that it has been linked to both short- and long-term Parkinson’s disease.
He added, “Sometimes the best seasickness medication, with the least side effects, is simply driving the boat. Perhaps it’s because you are in control of the boat, with an eye on the horizon. It usually works.”
An ounce of prevention
For most of us, serious medical challenges at sea are rare, but it can be rewarding to leverage winter months to increase our knowledge and make additions to our medical kits. Being prepared, with appropriate resources and skillsets, will help us avoid putting our crew and vessel in harm’s way once we get out on the water again
Four Resources
1. GW Medical Faculty Associates Maritime Medical Access, (202) 741-2911: gwdocs.com/specialties/emergency-medicine/wecc/maritime-services
2. CPR/AED and First Aid for Boaters, March 15, sponsored by CAPCA: capca.net/education
3. Safety at Sea Seminar, March 29-30: mtam.org/safety-at-sea
4. “Marine Medicine: A Comprehensive Guide, Adventure Medical Kits, 2nd Edition” by Eric Weiss and Michael Jacobs
~By Captain Cheryl Duvall
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