Scrub In

You’re sometimes far from help when cruising, so be prepared for a medical emergency
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It makes sense to get serious about medical preparedness by training, particularly if you run offshore, far from facilities. 

It makes sense to get serious about medical preparedness by training, particularly if you run offshore, far from facilities. 

I took my original CPR and first-aid class as a mandatory sailing instructor requirement. As a blasé teenager, I never thought I’d use the skills. I soon learned how effective the training was in a crisis. After expelling a huge projectile from a choking person’s airway using the Heimlich maneuver, I was awed and humbled as I realized I saved someone’s life. I’ve been serious about medical preparedness ever since.

One of the realities of boating is that we’re often far away from help. In near-shore waters, getting help is as easy as calling the U.S. Coast Guard on the VHF radio, but what if you’re offshore and days from any facilities? Even with a satellite phone or single-sideband radio, you will find yourself playing ship’s doctor in the time it takes for you to get to medevac helicopter range or to make landfall near a hospital.

An effective effort takes preparation before you have a medical crisis. The two most important things you can do to prepare are to get medical training, and to assemble your well-thought-out medical kit. Also be prepared to improvise in a pinch. You can be confident, backed by “Good Samaritan” laws, that you are protected if you give reasonable assistance to the injured or ill.

First, get training and stay current. Staying current keeps you practiced, and you’ll have access to the latest techniques and gear. At the least, take the American Red Cross Adult/Pediatric First Aid, CPR and AED (automated external defibrillator) course. Then assess what kind of boating you do. Picnics and day fishing, coastal cruising, offshore racing or long-distance voyaging all have different demands. Is there someone else normally aboard who is trained in first aid and CPR, or who has a medical background? If you plan on being remote and have no one to back you up, then by all means, choose a course for offshore and wilderness medicine.

Practice periodically. It’s better to find something amiss in an exercise than in a real emergency. I learned that lesson at a shipboard drill during which I practiced responding to an injured victim who needed to be loaded into a litter (a basket used for helicopter evacuation). Everything went well until it was time to move the patient out on deck to the rendezvous area. We discovered that the companionway was too narrow for the length of the litter to make the turn.

Getting a standard first aid kit is easy. A basic one required by law is less than $50, and contains an assortment of bandages, over-the-counter medications and other essentials for cuts, burns and sprains. But that type of kit is hardly what you’d need in a real medical emergency. At the other extreme, an offshore voyaging medical kit can cost more than $1,000. With many options in between, consider your own needs and your expected cruising range away from medical facilities.

Check your kit’s contents at least once every six months for age and condition. Many medical suppliers offer a service to keep on top of expirations. Pain meds? Anyone who has ever broken a limb or rib knows how important pain management is, particularly on a small, heaving vessel.

Of course, no first-aid kit is complete without a crew that knows how to make the best use of it. A good medical guidebook is essential to look up a procedure or find dosing information. Somehow, I’m comforted to know the guidebook I have
explains in detail how to deliver a baby.

Once you are trained and have the right tools, be guided by the mantra “do no harm.” Weigh the benefits of your actions versus the risks in assisting a shipmate. Keep calm, analyze what and who you have on board to mitigate the medical emergency, and do only what is necessary. Your job is to stabilize someone injured until professionals take over.

Sometimes, imaginative solutions are necessary. In a bad accident on board an oil tanker, we responded to a man in a lifeboat alongside. He wasn’t breathing. It was a challenge in a seaway to load him in the litter while someone breathed for him. We realized that the patient would be without a breather as we hauled him up the side of the ship from the lifeboat. We assembled a team to lift him swiftly, and designated a new breather to take over. The unresponsive seaman was hauled up and landed on deck, where someone else started breathing for him until the emergency helicopter arrived.

An armchair survivalist can dream up a long list of items that should be on board in a medical emergency. Spine boards, cervical collars, protective eyecups, specialty splints and for-purpose bandages are deluxe items to have. And a resourceful MacGyver can use anything to outwit the ever-present Murphy. A locker door or a surfboard can be transformed into a spine board, with rolled towels on both sides of the patient’s head, restrained with duct tape. Battens, charts and magazines can be fashioned into arm or leg splints. A sheet or towel can be transformed into a triangular shoulder sling. Have a suspected neck injury? A collapsed baseball cap with the inverted bill under the chin is an effective solution—secured with more duct tape. Frozen food makes for lovely ice packs. You get the idea.

My most memorable stand-in rig worked perfectly. A heavy sailboat icebox lid slammed down on the cook on a sea passage, breaking many of the bones in her hand. She was in excruciating pain until we inserted a cardboard toilet paper roll between her curved fingers and thumb, and taped it all together with her wrist splinted to her palm. We controlled the swelling with ice and made a major course change to the nearest port with a hospital. It was a clasic “do no harm” scenario.

Give comfort measures freely. Position your patient effectively. Direct pressure and elevation will control most bleeding. Immobilization and correct positioning of the passenger’s injured part reduces pain, even if there is no fracture. Control the patient’s temperature. Learn the symptoms and treatment for shock, fever onset, hypothermia and dehydration. Use your medical guidebook.

Monitor and record vital signs to recognize changing conditions or abnormal readouts. Ideally, you should record resting blood pressures (if you have a cuff), pulse and its characteristics, respirations and temperature. And remember your training and medical emergency manual should be your guide.

I’m not an EMT, and you probably aren’t either. Focus on the need for training, preparing a medical kit and improving your skills. We hope all goes well out there, but an accident or illness can befall us at any time. Hope is not a plan, so be prepared.

This article originally appeared in the August 2019 issue.