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Preparing for Emergencies at Sea

For many cruising sailors, first-aid training and preparation are afterthoughts, but they should be at the top of the to-do list before heading offshore.
safety at sea
There are several companies and organizations that offer comprehensive first-aid kits, such as this one from the Divers Alert Network. Another service that DAN provides is called DanBoater, an affordable medical-emergency system with paramedics on call 24/7 on a dedicated hotline. Stephen Frink

When I decided to sail across the Atlantic aboard Ranger, my 30-year-old Allied Seabreeze yawl, I spent a year refitting her. I slept with and dreamed about marine catalogs, and spent thousands of dollars on things to keep the boat moving and the crew aboard.

A month before ­departure, my first mate, a trusted, ­levelheaded sailor and nurse, called with bad news. He had just been diagnosed as HIV positive.

Suddenly, my nightmares of a man overboard or a hole in the hull became visions of bleeding cuts, gloves, barriers, sanitation, and dealing in close quarters with a sick man still juggling his new medical cocktail. It was the first time I’d thought about the health of my crew.

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Ultimately, he elected not to go, as did my third crewman. The nurse packed a first-aid kit, and I threw it under the sink and took off with two strangers, prepared to handle anything the sea might hand us, I thought. But we weren’t ­prepared. And from everything I’ve gathered, neither are most sailors who set out on extended cruises.

A sailboat is a hazardous platform in a hostile environ­ment. People on sailboats get cut, conked, bruised and burned, and can become nauseated, crushed, dehydrated, cold and sprained — and those are just the common problems. Sailors also bring with them an encyclopedia of pre-existing medical conditions, from obesity and age to heart disease and diabetes. All are compounded by the isolation of a vessel at sea.

“The majority of sailors are not prepared for ­medical emergencies,” says Dr. Miles Poor, a surgeon, offshore sailing veteran, and longtime fleet surgeon to the Caribbean 1500. Because Americans are used to a “911 mindset,” he says, we forget that even a mile offshore, we must be our own first responders. Yet most of us are untrained.

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According to the U.S. Coast Guard, in 2015 in U.S. waters, 5,560 boats were involved in accidents with injuries or deaths. Only five — five! — of the skippers involved had American Red Cross first-aid training.

“People get drawn toward gadgets: Do I have the right sails? Do I have the right navigation tools? That’s great. But we need to think through the medical side of things, too. Is my first-aid kit appropriate? Do I know how to use it? Do I know what is in it?” says Dr. Jeffrey Wisch, a sailor, hematologist, and oncologist at the Dana-Farber Cancer Institute in Boston, and the fleet surgeon of the Cruising Club of America, which runs the Newport Bermuda Race.

One study of transatlantic sailors by a French physician found that half of them waited until the final month prior to departure to think about a first-aid kit. Fifteen percent didn’t deal with it until two weeks before setting sail, reports David Hayes, a University of Quebec chiro­practic professor and sailor who teaches seminars for the World Cruising Club.

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Hayes’ own survey of hundreds of sailors in the World Cruising Club’s rallies indicates that 65 percent wait until the last month to get any first-aid training. He remembers vividly, three days before departing the Canaries for the Caribbean, being approached on the docks by a mother. “Can you recommend a good first-aid book?” she asked. She was about to set off for at least 20 days at sea with her ­husband and children.

safety at sea
Hands-on medical training aboard a yacht, such as that offered by the Fowey Maritime Centre in the United Kingdom, is an excellent way to learn the basics in real-world situations. Fowey Maritime Center

“If there’s an emergency, you won’t have time to pick up a book,” Hayes says. “There are steps you need to take, that you need to be trained for.”

Medical experts can ruin your daydreams with accounts of offshore emergencies: fingers cut off by fishing line, then cauterized in a frying pan in the middle of the Indian Ocean; a painful, untended dislocated shoulder during 15-foot waves from Hurricane Mitch; a mid-Atlantic lurch that knocked a sailor into a winch and left him brain-dead; a Gulf Stream chin laceration that required 12 sutures from Wisch — each stitch timed between waves.

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Cruisers also explore exotic and primitive places. Daniel Nord, director of medical services for the Divers Alert Network, which reviews 5,000 calls for help a year, lists three pieces of advice: 1) Don’t rent a motor scooter, 2) don’t pet the monkey, and 3) don’t ride the elephant! He’s half-joking, of course, but there’s a lesson in there, too. Common sense can go a long way toward preventing mishaps.

Two people have died in 30 years of the Atlantic Rally for Cruisers, both after being struck in the head by a boom. But the most common injuries have been galley cooking burns, followed by rope burns (some down to the bone), cuts, punctures from fishhooks and knives, and many blunt traumas — bruises, bumps and broken bones — caused by falling around the boat, says Jeremy Wyatt, World Cruising’s director.

There are many easily learned first-aid techniques that cruising sailors can master: taking vital signs, treating burns, making splints and stopping bleeding. “First-aid training has prevented a bad situation from becoming worse,” says Wyatt. “Eight years ago, one sailor broke his arm and suffered a puncture wound. The crew had the perfect dressing and splint, and thought about where to put the sailor, in a bunk where he couldn’t move. That was a well-prepared crew.”

The vast majority of the 2,613 injuries and 626 deaths reported by the Coast Guard in 2015 were preventable. Drinking alcohol and not wearing a PFD were often contributing factors. “The first thing that goes onto a boat is a full cooler,” says Vann Burgess, the Coast Guard’s senior recreational-boating safety specialist. “People never expect to enter the water. Any sailor should be wearing a life jacket. It will keep you alive.”

Most problems can be prevented or treated with some training and common-sense forethought: simple stuff like hygiene, hydration, adequate sleep, seasickness pills, wearing shoes and gloves, and wearing a clipped-in PFD. First-aid kits should contain supplies that a crew can use. A suture or IV kit is useless without training. But you can use suture strips, and knowing just a little anatomy will help describe symptoms when you call for help.

As much as I pride myself on CPR and defibrillator training, I have learned that offshore, it might help in a drowning or shock but would not likely save a cardiac arrest, because of the need for follow-up meds. The $2,000 spent on an automatic external defibrillator “could be better spent on first-aid training,” says Wisch.

“Sailors think about doomsday scenarios on their boats,” says Hayes, “but appendicitis can happen to anyone, and that’s life-­threatening. They need to be prepared for anything. The statistics say anything can and will happen.” Miles Poor tells his offshore classes: “In an hour, I’m not going to try to make you a doctor. But I want to make you realize that if you ask questions and can relay symptoms, you can go safely offshore, never have an issue, and have a good time.”

Transatlantic veteran Jim Carrier is a former award-­winning journalist for The Denver Post and the author of The Ship and the Storm, a riveting account of the loss of the 282-foot schooner Fantome during Hurricane Mitch in 1998.

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