How to cope with a medical emergency at sea

How do you prepare for every first aid eventuality including a medical emergency at sea? We get expert advice on how to prevent medical incidents offshore, and what to do if you need helpWithout medical services, how do you keep yourself, your crew, or your family healthy? It’s one of the most daunting elements of sailing offshore.
We joined crews preparing for the Grand Large Odyssey: a three-year, 35,000-mile round the world rally organised by Grand Large Yachting, builders of Outremer, Gunboat, ORC, RM, Allures and Garcia brands, for owners of those boats (the next edition starts in November this year).
Ahead of the rally start, GLY held a ‘World Odyssey University’; a week-long series of seminars and networking events crammed with information for participants.
One of the recurring topics was healthcare on board, including a full-day seminar led by Dr Matthieu Coudreuse, an ER doctor who specialises in medicine in isolated and offshore environments. Coudreuse has worked as the onboard doctor on an icebreaking expedition vessel, in remote tropical clinics and with disaster relief teams. The GLY entrants also heard a presentation by previous rally crews on how to avoid or handle health issues based on their experiences and learnings. These are some of the key takeaways:
A medical kit to cover most likely eventualities is essential offshore
Before you go
Preparing the humans is as important as preparing the yacht. Just as you wouldn’t set out without servicing the boat’s engine, allow enough time for medical checks, including a visit to the GP, optician and dentist. Advice is that ‘men of a certain age’ should also consider visiting a urologist.
If you have any health conditions that require ongoing medication, such as diabetes meds or blood thinners, discuss with your doctor how to carry enough supplies to allow for delays or re-routing.
Look at the areas you plan on, or might consider, visiting and ensure you’re up to date on vaccinations (eg hepatitis, rabies, tetanus, typhoid, yellow fever or encephalitis). Proof of vaccination is mandatory for some countries. Make sure any crew or guests planning on joining the voyage do the same, and that everyone on board has comprehensive health insurance.
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On a long passage, also plan to incorporate ongoing health checks – many countries along the way will offer good, affordable health and dental care. Previous GLY rally crews accessed treatment in Panama, Tahiti, Noumea, Reunion, Mauritius and South Africa.
Dedicate time to more advanced medical training – a basic First Aid at Sea should be the minimum, but there are multi-day courses suitable for situations where you may not be able to access medical help for days, including from marine specialists such as MSOS (msos.org.uk).
You might consider signing up for a tele-med service – there are several private providers that offer a dedicated e-medicine service for offshore sailors, in addition to the MRCC-connected TMAS services (see over the page). Anyone using the French TMAS service can send their medical records to their Toulouse base in advance.
And consider your own fitness – back sprains etc are a common problem and can be debilitating. Working on your own strength, core stability and balance before setting off can help reduce the risk of injury.
Skin welts from a jellyfish sting can be very painful. Photo: Adrian Weston/Alamy
Get prepared
Preparing for all medical eventualities is impossible, and health issues completely unrelated to sailing can always rear their head, but having a good awareness of your own health is key as getting an early and accurate diagnosis is critical.
You can work out what your greatest risk factors are, to prepare to mitigate them. The most common risks include: skin problems due to exposure to sun; wet/saltwater and problems with wound healing; food and drinking water contamination; the boat itself; and risks associated with stopovers.
During the previous two-year GLY world rally there were a small number of serious incidents, including a broken leg when a crew member was flicked overboard by the mainsheet while sailing in 4m waves, and safely recovered. Another dislocated their shoulder falling through an open hatch when walking on deck. A skipper dived to attempt to free their stuck anchor, but their air tank ran empty at 15m depth and they ascended too rapidly. And a seemingly innocuous incident led to a helicopter medi-vac after one crew member cut their feet on coral, which caused an infection that didn’t respond to antibiotics.
Be confident in basic first aid, including CPR. Photo: Grand Large Yachting
What to pack
When offshore or in many remote areas, your onboard medical kit will be your only resource, so spend time considering what to carry. There is no compulsory list of medicines to carry, only advisories – rally organisers and tele-med services can help, while TMAS France publishes two lists, for vessels 0-60 miles offshore, and 60 miles-plus.
As a starting point, you should carry treatments for seasickness, cuts and wounds, burns, bruising and broken bones, allergic reactions, hypothermia and sunstroke, infections, skin problems, and digestive problems.
Every first aid kit should have some sort of pain relief – from paracetamol and ibuprofen. Stronger analgesics, such as opiates and anti-inflammatories, will need a prescription (also include anti-sickness medication, as opiates can make many people sick). Always talk to a medical professional before administering opiates, and be aware of laws on restricted substances, such as morphine, when crossing international borders.
If any crew have known allergies or asthma they should have their own EpiPen or inhaler, with spares in the first aid kit. Even if you have no known allergies on board, consider carrying an EpiPen as you’ll likely come into contact with new foods, insects etc.
More advanced skills such as suturing or stapling wounds will need practice ashore before being attempted afloat. Photos: Grand Large Yachting
A range of dressings can be useful, including gauze, steristrips and tape. Suturing can be immensely difficult for inexperienced first-aiders, particularly on a moving boat, so a staple kit can be easier – but still requires training and practice beforehand. Consider carrying plastic or inflatable splints and a neck brace for any suspected broken bones or spinal issues.
Burns are surprisingly common at sea. Make sure the boat has both washes for chemical burns and scald treatments, as well as waterproof dressings to prevent infection. Diagnostic tools such as a pen torch to assess pupil dilation, mirrors, urine dip sticks, a thermometer, scalpels, scissors, needles and syringes should be kept in sterile waterproof packaging.
Consider if you want to carry a small bottle of oxygen in case of suspected drowning or respiratory issues. Or even a defibrillator – which can be helpful in an emergency, but is relatively heavy and bulky.
But the more comprehensive your onboard medical kit, the more you need to be aware of drug interactions – for example, medication that a crew member is taking for a chronic condition with a drug taken to treat a new issue. Do not administer prescription medicines without medical advice from a tele-med service or similar.
Keep tablets, drugs and treatments well labelled and in waterproof bags or containers in your medical kit. Photo: Pip Hare Ocean Racing
Prevention over cure
Tropical environments bring their own challenges. For example, mosquitos can fly more than two miles over sea, potentially carrying malaria, dengue, chikungunya, yellow fever, or zika fever. Prevention – avoiding getting bitten – is best, although you can do a self-test for malaria onboard to avoid taking anti-malarials, which just involves a single blood prick.
Digestive issues such as gastroenteritis and parasites again mostly require prevention. A rule to reduce risk is ‘Cook it, boil it, peel it, or forget it.’
Watch out for drinking water and ice served ashore, as well as making sure your own water supply on board is safe (keep on top of filters, tank hygiene etc). There’s an added risk of dehydration when gastro issues combine with sailing, so carry rehydration and electrolyte sachets.
Travellers in the tropics can be at risk of Leptospirosis – avoid by not eating fallen fruits from the ground, or drinking from bottles in cafes/beach bars. Ciguatera can be avoided by not eating fish caught in some areas – check official and local sources to avoid risky catches.
In Vanuatu, nearly all the rally crews picked up some kind of infection, even from a simple splinter. Antibacterial gel is often ineffective – focus instead on handwashing with soap and being careful to dry your hands, and use alcohol to treat. Other key items to have in your armoury are tweezers and natural topical treatments which often have no expiry date, such as tea tree oil (antibacterial and anti-fungal), lavender aspic to treat insect bites, helichrysum or peppermint oil for bruises, and tiger balm for sprains and strains.
Events such as Outremer Week and the GLY rally ‘University’ include medical training seminars
If you need help
If you do have an emergency or require medical assistance on board while offshore, Dr Coudreuse emphasised that the first thing to do is check that the boat is secure, and the rest of the crew is safe. Prevent further accidents – before you begin taking care of the patient.
Assess the severity of the situation: are they bleeding? Have they lost consciousness?
Carry out any basic first aid needed: recovery position, chest compressions etc. If possible, take photos of their injury, skin colour etc, which can be useful for a tele-med diagnosis.
In a critical situation, first call TMAS or the tele-med service, but have email ready to send photographs or other information.
Make sure you know the medical history of the patient: do they have any allergies, pre-existing conditions etc? Then you will likely need to examine them: determine location of any pain, measure blood pressure, heart rate, breathing frequency, oxygen saturation levels, temperature and other key observations. There are forms you can download in advance with prompts to guide you through the process.
Patching up during The Ocean Race Sprint Cup
Dr Coudreuse explained that it’s important when observing and describing a patient’s condition to be very specific. For example, saying they have ‘difficulty breathing’ gives limited information. While a wheezing noise on exhalation is a classic sign of asthma, in children a noise on inhalation often indicates an object in the upper airways. Likewise, when describing pain, the more specific you can be, the more able a remote doctor will be to diagnose the problem – for example, kidney stones cause a very characteristic type of pain.
But be reassured, according to Dr Coudreuse when the crew are the eyes and ears of the doctors, 70% of situations can be satisfactorily handled on board.

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