Firstly, the good news is that you can get your training from a specialist, such as Red Square Medical, where all of our instructors understand boats and the ocean and can tailor the course to your specific requirements. We can even teach it onboard your boat! We do recommend a basic level of knowledge such as the RYA First Aid at Sea course to give you a good start, but it’s not essential.
There are 3 main issues when you’re trying to carry out first aid onboard any boat:
1. Lack of space.
2. A potentially unstable environment - picture bad weather and rolling seas.
3. The potentially long time period to wait for definitive care - it will take a lot longer to get help than when you’re on land and you may have to wait hours, days or in extreme cases, weeks.
So here’s a list of 10 things that you might like to consider for first aid at sea…
1. It’s only a bump on the head!
- How many times have you bumped your head on a boat? You probably can’t remember but hopefully haven’t ever done too much damage.
The thing to remember about head injuries is that you can’t see what damage has been done inside. It can take hours or days for symptoms to appear, so it’s important to write down the details of the accident and monitor the casualty closely as changes can creep up over time.
Immediate red flags after a head injury are any obvious skull deformity, loss of consciousness, unequal pupils, cerebrospinal fluid (CSF) or blood leaking from the ears, nose or mouth. Other warning signs either immediately or later include confusion, behavioural changes, loss of balance, changes to speech, headaches, numbness or pins and needles, vomiting or visual disturbances.
2. There are quick fixes to keep someone alive in an emergency, make sure you know what they are!
You also need to have the equipment in your medical kit and know how to use it. If you choose to carry medication that is normally only given on prescription you will need to work with an authorised supplier to acquire it and have training, plus telemedicine support, in order to use it.
Haemostatics (blood clotting agents) are great to have around for major hemorrhages and they are available in different presentations suitable for all kinds of wounds. Just put in contact with the bleed, apply pressure and the you can leave the rest up to the clotting agent.
Epipens can be handy and should be essential if you have anyone on board who suffers from allergies. Epipens deliver a shot of adrenaline to counteract anaphylactic shock (extreme allergic reaction) and buy a bit of time to get help and administer longer acting drugs.
Know your crew and work out what kind of lifesaving items and quick fixes you want to have onboard.
3. This brings us nicely to knowing your crew! Make sure you have a record of the medical history of the crew and any guests on board. Be proactive rather than reactive.
If someone has a health issue – perhaps a respiratory condition, allergy, diabetes, epilepsy or a heart condition it’s much better to know that from the start rather than finding out during an emergency.
Also, illness, seasickness and dehydration can cause normally sensible people to forget to take medicine or even take too much. Vomiting can be serious if it leads to dehydration or means the casualty can’t keep oral medications down. Ask those who take regular drugs or inhalers to keep them in a known location so that others can access them easily in an emergency.
4. Take spares!
Anyone can get seasick or a vomiting bug that means they can’t keep medications down. Your boat could be stuck somewhere, or delayed, for any number of reasons, and now you may have to isolate or quarantine due to COVID-19 regulations. Your destination country may have different rules on prescription medications which means you can’t get hold of regular meds quite as easily.
Remind everyone onboard to bring sufficient medication for a period longer than your voyage. For those who require emergency medications such as inhalers for asthma or Epipens for anaphylaxis, make sure they are stored in a central location where everyone can find them easily.
5. You want me to leave the glass in the wound?
Foreign bodies that get stuck in the body need to remain in the body. If a crew member gets a large piece of glass stuck in their body, or a piece of metal through the leg or any foreign body larger than specks, it’s very important to leave it in!
The foreign body could be near to, or partially through an artery, so pulling it out could cause a larger problem. When you consider that help might be hours or days away, it’s important to prevent a more serious issue. Don’t make more work for yourself! Stop blood loss, clean the wound and bandage it up as best you can, protecting the body and the foreign object. They will need to go to hospital.
6. Burn, baby, burn! It’s important to know that burns keep on burning underneath the skin until they are completely cooled down. The best remedy is running under cold water for at least 20 minutes, though this may not be practical on a boat.
Alternatives include wrapping cold packs in a tea towel to apply, or even putting a burn in a bucket of water is better than doing nothing. Gels and some burn dressings can be useful short term but will have to be scraped off in hospital, so the initial relief may not be worth the longer term pain and many hospitals prefer you to avoid them. Once cooled, wrap loose strips of cling film over the burn to protect it, or a paraffin dressing and top with a light bandage to hold it in place. Be aware that burns can cause a loss of fluid and even blisters mean body fluid isn’t where it should be so avoiding dehydration is an important consideration.
7. Packing for a medical evacuation?
When a casualty is Med Evac’d (most likey by air) make sure you pack all the essentials… medical notes, detached body parts, their passport and some money! The following items can be really useful:
- Written record of events - what happened, how, when, for how long, etc.
- First Aid given – any vital signs/observations taken such as blood pressure, temperature, etc. and any drugs administered with the amount and time of administration.
- Any missing parts, like fingers, need to be put in a bag with a little trapped air, wrapped in cloth and kept cold but not frozen in a fridge or cooler. Keeping detached body parts cold will massively increase the chances of the parts being saved.
- Pack the casualty with their passport, money/credit card and a mobile phone. When they are discharged from hospital they may not be able to get back to the boat easily and may have to make alternative arrangements.
8. It’s going to take how long?
Although a 999 call on land may take some time for non life threatening emergencies could take several hours these days, you can guarantee they will be aiming to get to you within 8 minutes for something that is life threatening. Not so at sea!
If someone stops breathing it could take up to an hour for help to arrive. If they’re bleeding out, and help is 6 hours away, what will you do? Onboard any kind of boat, YOU
need to know how to keep someone alive for hours and/or days, not just a few minutes. It’s also important that everyone is medically trained - because who’s going to look after you if you’re the one that’s ill or injured?
9. Stay on deck!
Sometimes you want to instinctively get someone down below for comfort and safety. But, it could make the extrication ridiculously complicated and force you to work in an even more confined space.
This is really important if your casualty is unconscious. For Med Evac by air, it’s far easier to work with them on deck than trying to lift them up the companionway when they’re a dead weight.
10. Think. Then act.
Remember the basics of DRSCABCDE. Just because someone looks like they can’t breathe doesn’t mean it’s life threatening asthma, it could be a panic attack. Chest pain doesn’t always mean a heart attack. If they’re talking, they’re breathing and you can relax a little. If not, then follow the algorithm and get help running sooner rather than later. Take observations/vital signs and build up the information that will help you when speaking to either emergency services on land, or your Telemedicine provider.
The sand on the beaches near boats is not the place to stick your head! The ocean is a harsh environment and you need to be prepared.
Lots of people worry about things like ‘what if I do CPR and the casualty still dies?’. Well, it might sound brutal, but the statistics show that they probably will despite your best efforts. But what if they were in the 10% who survive? What if you did CPR and saved a life, or at least gave it your all to give them the best chance possible. How good would that feel?
So, get some training, know your medical kit, keep some reference materials on board (we can recommend), know how to use your communications equipment to get help. Speak to the team at Red Square Medical and we can help to put together the best possible training and support package so you can enjoy your boating worry free.
If your position on First Aid at sea has always been to let someone else get stuck in, you might need to think again if you’re planning to be more than a couple of miles offshore. Remember that at sea, first aid knowledge could be the difference between someone you love living, or dying! Scary stuff!