Worse Things Can Happen At Sea: Part ONE

Part one: Getting Prepared

Dealing with medical emergencies at sea.

By Major Henry Chandler MBChB, MRCS, DMCC And Dr Chris Chandler FRCOG

Serious medical events at sea are relatively uncommon, but if they do occur, and if the skipper is not prepared, at best the passage plan will be disrupted, at worst a limb or even a life may be lost. The operational range of a Sea King helicopter is a shade over 300Nm so within a couple of days you really are on your own. In this, and in the next two editions of the magazine, we are going to highlight the areas that we think every responsible skipper should consider before setting sail on any significant offshore passage. This month we discuss preparation, in the next two articles we cover medicines and medical conditions you may encounter.

Know your crew

You’ve sailed with them before, they’re sturdy types, but did you know that John is a diabetic, Gill has a pacemaker and Frank takes pills for high blood pressure and cholesterol? 

Get over any potential embarrassment by asking each crew member, before they join, to fill out a short medical questionnaire (see right) which you as skipper and any medically trained member of the crew will check and then store securely. Make sure that anybody taking prescription medicines has a generous supply. That three week “hop across the pond” may take considerably longer if the weather takes a turn for the worse or the yacht suffers unexpected damage or gear failure.

Medical Questionnaire 

• Name
• D of B
• Regular medication 
• Occasional medication
• Allergies
• Medical History
• Serious illnesses
• Operations
• Heart problems
• High Blood Pressure
• Raised cholesterol
• Diabetes

Know yourself

You are probably a Yachtmaster and have some basic First Aid knowledge but could you suture a deep wound? What antibiotics would you use to minimise the risk of sepsis from a tooth abscess or cut? There are a number of short courses available. The RYA offer a one day First Aid course specific to sailors – https://www.rya.org.uk/courses-training/courses/specialist/Pages/first-aid.aspx.

There are several longer courses organised by the MCA and a number of commercial organisations.

Decision making

When teaching basic First Aid to soldiers, the first step is always to “win the firefight”. Similarly, if a crew-member sustains an injury while the boat is suddenly hit by heavy weather the priority remains to keep the boat safe. Step one of the Basic Life Support course emphasises this, “Is it safe to proceed?” Do not let one injury risk the lives of the entire crew. 

Counter to this is the risk of ignoring medical problems for the sake of the trip. Sometimes this will involve difficult decisions for the skipper, such as turning back because you’re not convinced that John’s chest pain is indigestion as he claims.  The islands aren’t going anywhere so do not take unnecessary risks.  It makes sense to discuss these scenarios in the comfort of a harbour to ensure everyone has an idea of what might be required
of them.

What should we be prepared for?

• Burns / scalds / stings
• Soft tissue injuries 
• Cuts and bruises
• Sprains and strains / torn ligaments
• Bites (insect or acquired while swimming)
• Facial / eye injuries
• Dental problems
• Broken bones
• Fever (consider malaria or other tropical diseases depending on geographic location)
• Food poisoning
• Chest infection
• Heart attack
• Stroke
• Abdominal problems (appendicitis, peritonitis)
• Urinary infections / retention

Although it sounds daunting, serious medical problems are mercifully rare. On my last trip as the responsible medic, the most serious problem I had to deal with was a paper cut that required a sticking plaster!

Dick Beaumont has been sailing for over 50 years and sailed thousands of miles across the oceans of the world. On only two occasions has he encountered a significant medical problem and in both instances, common sense and basic medical kit were all that was required. The key, as for most things, is preparation and being ready for the unexpected.

What kit shall we take?

Only take that which you, or another crew member, can safely use, either alone, or with qualified medical help via your
sat phone.

Most commercially available First Aid kits will contain masses of triangular bandages and various dressings. Be sure to check the contents carefully, bandages should be stretchy to allow compression to stop bleeding or to support a limb. You are far more likely to require a simple sticky plaster than a bandage. In 10 years of medical practice as an Army doctor, I have never successfully applied a triangular bandage.  I believe they can be made into a sling hence the safety pins that find their way into almost every First Aid kit, but supporting the wrist with a rope or cord (small loop around the wrist larger one around the neck) is usually as effective. 

Rigid packing cases are generally unwelcome on a boat, but a First Aid kit in a solid waterproof container does have it’s advantages. Items tend to be well compartmentalised and organised in these cases. Check you can use your common items without having to open everything and expose them to the sea air. 

A commercially available First Aid kit which is sensibly stocked, waterproof and easy to grab is adequate, but once opened it may be prone to scattering and degradation of the contents. Consider restocking in a heavy duty plastic waterproof bag.

Typical first aid kit

What sources of advice are available?

Ship Captains’ Medical Guide, published by the MCA. This is an absolute must and is carried on all commercial ships. Available from Nautical Bookshops or Amazon for £35-40. A new edition is due out soon so unless your departure is imminent put it on your Christmas list.

Any sailor, of any nationality, can access advice from a doctor 24/7 by calling the UK’s Marine Rescue Co-ordination Centre at Falmouth, from anywhere in the world. However, the scope to deliver more advanced levels of care, and therefore the outcome, can depend heavily on what is carried on board and the confidence of the crew to carry out some basic medical procedures, such as giving injections, themselves.

With the wide availability of satellite communications there now exist a number of commercial organisations who offer various packages of medical support which is accessible from almost anywhere in the world 24hrs a day.

Next month, Part Two: Medicines