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\u2019s one of the most daunting elements of sailing offshore.
\nWe 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).
\nAhead of the rally start, GLY held a \u2018World Odyssey University\u2019; a week-long series of seminars and networking events crammed with information for participants.
\nOne 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:
\nA medical kit to cover most likely eventualities is essential offshore
\nBefore you go
\nPreparing the humans is as important as preparing the yacht. Just as you wouldn\u2019t set out without servicing the boat\u2019s engine, allow enough time for medical checks, including a visit to the GP, optician and dentist. Advice is that \u2018men of a certain age\u2019 should also consider visiting a urologist.
\nIf 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.
\nLook at the areas you plan on, or might consider, visiting and ensure you\u2019re 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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\t\t\t\t\t\t\tSeasickness: How to prevent it and how to cope with it<\/p>\n
\t\t\t\t\t\t\tOn one of my earliest trips as a professional sailor a wise old skipper gave me some seasickness advice at\u2026<\/p>\n
\t\t\t\t\t\t\tHow to manage your mental health at sea<\/p>\n
\t\t\t\t\t\t\tIt\u2019s a common misconception that \u2018mental health\u2019 only applies when we are experiencing a condition such as anxiety, depression or\u2026<\/p>\n
On a long passage, also plan to incorporate ongoing health checks \u2013 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.
\nDedicate time to more advanced medical training \u2013 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).
\nYou might consider signing up for a tele-med service \u2013 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.
\nAnd consider your own fitness \u2013 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.
\nSkin welts from a jellyfish sting can be very painful. Photo: Adrian Weston\/Alamy
\nGet prepared
\nPreparing 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.
\nYou 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.
\nDuring 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\u2019t respond to antibiotics.
\nBe confident in basic first aid, including CPR. Photo: Grand Large Yachting
\nWhat to pack
\nWhen 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 \u2013 rally organisers and tele-med services can help, while TMAS France publishes two lists, for vessels 0-60 miles offshore, and 60 miles-plus.
\nAs 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.
\nEvery first aid kit should have some sort of pain relief \u2013 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.
\nIf 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\u2019ll likely come into contact with new foods, insects etc.
\nMore advanced skills such as suturing or stapling wounds will need practice ashore before being attempted afloat. Photos: Grand Large Yachting
\nA 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 \u2013 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.
\nBurns 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.
\nConsider if you want to carry a small bottle of oxygen in case of suspected drowning or respiratory issues. Or even a defibrillator \u2013 which can be helpful in an emergency, but is relatively heavy and bulky.
\nBut the more comprehensive your onboard medical kit, the more you need to be aware of drug interactions \u2013 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.
\nKeep tablets, drugs and treatments well labelled and in waterproof bags or containers in your medical kit. Photo: Pip Hare Ocean Racing
\nPrevention over cure
\nTropical 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 \u2013 avoiding getting bitten \u2013 is best, although you can do a self-test for malaria onboard to avoid taking anti-malarials, which just involves a single blood prick.
\nDigestive issues such as gastroenteritis and parasites again mostly require prevention. A rule to reduce risk is \u2018Cook it, boil it, peel it, or forget it.\u2019
\nWatch 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\u2019s an added risk of dehydration when gastro issues combine with sailing, so carry rehydration and electrolyte sachets.
\nTravellers in the tropics can be at risk of Leptospirosis \u2013 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 \u2013 check official and local sources to avoid risky catches.
\nIn Vanuatu, nearly all the rally crews picked up some kind of infection, even from a simple splinter. Antibacterial gel is often ineffective \u2013 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.
\nEvents such as Outremer Week and the GLY rally \u2018University\u2019 include medical training seminars
\nIf you need help
\nIf 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 \u2013 before you begin taking care of the patient.
\nAssess the severity of the situation: are they bleeding? Have they lost consciousness?
\nCarry 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.
\nIn a critical situation, first call TMAS or the tele-med service, but have email ready to send photographs or other information.
\nMake 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.
\nPatching up during The Ocean Race Sprint Cup
\nDr Coudreuse explained that it\u2019s important when observing and describing a patient\u2019s condition to be very specific. For example, saying they have \u2018difficulty breathing\u2019 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 \u2013 for example, kidney stones cause a very characteristic type of pain.
\nBut 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.<\/p>\n
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The post How to cope with a medical emergency at sea appeared first on Yachting World.<\/p>\n","protected":false},"excerpt":{"rendered":"
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 … <\/p>\n