First Aid and Medical Emergencies

Prerequisites

• Day Skipper level experience and the sea time for the Coastal Skipper course (15 days, 2 as skipper, 300 miles, 8 night hours).
• To sit the Yachtmaster Coastal exam you must hold a valid first aid certificate: the RYA First Aid Certificate (one day, at least 6 hours, designed for water users), STCW Elementary First Aid, Seafish First Aid or an equivalent meeting the RYA minimum. UK registered medical professionals may use their registration instead. Certificates are refreshed every 3 years (STCW up to 5).
• An SRC certificate, since getting medical help at sea depends on the radio (see the GMDSS and DSC lesson).

This lesson does not replace a practical first aid course; CPR and bandaging must be practised hands-on. It shows how first aid applies on a yacht, what a skipper must organise, and how to get help.

Learning Objectives

This lesson covers the first aid and emergency-care knowledge expected of a Coastal Skipper and assessed in the Yachtmaster Coastal practical, where the RYA requires a valid first aid certificate (at least 6 hours, covering CPR, recovery position, bleeding, shock, hypothermia, head injuries, breathing difficulties, choking, chest pain, seasickness, diabetic emergency, anaphylaxis, hyperthermia, fractures, seizures, burns, minor injuries and equipment selection). By the end you will be able to:

• Carry out a primary survey (DRABC) and manage an unresponsive casualty, including CPR and the recovery position, on a moving boat. (RYA syllabus: assessment of a casualty, resuscitation.)
• Perform a secondary survey, take and record observations, and pass them accurately to a doctor. (RYA syllabus: radio medical advice.)
• Control bleeding, recognise and treat shock, and manage head, spinal, fracture, crush and burn injuries. (RYA syllabus: bleeding, shock, fractures, burns, head and spinal injuries.)
• Recognise and treat hypothermia, cold water shock, drowning, seasickness, dehydration and heat illness, and care for a casualty recovered from the water after a man overboard. (RYA syllabus: hypothermia, drowning, seasickness, hyperthermia.)
• Recognise medical emergencies common at sea: chest pain, stroke, anaphylaxis, diabetic emergency, seizures, choking. (RYA syllabus: breathing difficulties, chest pain, diabetic emergency, anaphylaxis, seizures.)
• Recognise marine-specific hazards: carbon monoxide, fish hooks, stings, electric shock and eye injuries.
• Obtain radio medical advice through HM Coastguard and TMAS and prepare for a helicopter or lifeboat evacuation. (RYA syllabus: helicopter evacuation, radio medical advice.)
• Organise a first aid kit and medicine log appropriate to coastal passages, and manage the skipper's duty of care for the crew. (RYA syllabus: equipment selection.)

The Skipper's Medical Responsibilities

At sea, help is not eight minutes away. Even 10 miles offshore, a lifeboat may take 30 to 60 minutes and a helicopter longer. The skipper is responsible for:

• Knowing the crew: before departure, ask privately about medical conditions, medication, allergies and seasickness history. Record next-of-kin details.
• Ensuring someone else on board can use the radio and give first aid, in case the casualty is the skipper.
• Carrying a suitable first aid kit and knowing where it is.
• Deciding early when to call for advice, when to divert, and when to request evacuation.

Primary Survey: DRABC

Every casualty assessment starts the same way, as the diagram shows.

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1. Danger. Make the boat safe first. Who is steering? Is the engine or a flapping sheet still a hazard? Is the boat about to gybe? Clip yourself on. A second casualty helps nobody.
2. Response. Speak loudly and tap the shoulders. Use AVPU to record the level: Alert, responds to Voice, responds to Pain, Unresponsive.
3. Airway. Open the airway with head tilt and chin lift. If spinal injury is suspected and you are trained, use a jaw thrust. Look in the mouth and remove obvious obstructions.
4. Breathing. Look, listen and feel for normal breathing for no more than 10 seconds. Occasional gasps (agonal breathing) are not normal breathing.
5. Circulation. Look for and control major bleeding; assess skin colour and pulse.

If the casualty is unresponsive and not breathing normally: shout for help, get someone to send a MAYDAY (this is a life-threatening emergency), and start CPR.

CPR on a Yacht

• Place the casualty on their back on a firm surface: the cockpit sole or cabin sole is better than a bunk.
• Kneel beside them, heel of one hand in the centre of the chest (lower half of the breastbone), other hand on top, arms straight.
• Compress 5 to 6 cm at 100 to 120 per minute, allowing full recoil.
• After 30 compressions give 2 rescue breaths, each about 1 second, watching the chest rise. Use a face shield or pocket mask.
• Continue 30:2 without interruption. Swap rescuers every 2 minutes if possible; CPR is exhausting, especially in a seaway.
• Brace your knees or back against a fixed part of the boat so the motion does not throw you off.

Drowning casualties are different because the cause is lack of oxygen: give 5 initial rescue breaths before starting 30:2. If an AED (defibrillator) is available, use it as soon as possible, but dry the chest and move the casualty off a wet metal or flooded surface first.

When to stop: when the casualty starts breathing normally, when you are relieved by a professional, or when you are physically exhausted and cannot continue. In remote locations, follow the advice of the TMAS doctor.

The Unconscious but Breathing Casualty

A casualty who is unconscious but breathing normally must have their airway protected, because their tongue or vomit may block it. Place them in the recovery position:

1. Kneel beside them. Place the arm nearest you at right angles to their body, elbow bent, palm up.
2. Bring the far arm across the chest and hold the back of their hand against the cheek nearest you.
3. With your other hand, lift the far knee so the foot is flat on the floor.
4. Pull on the far knee to roll them towards you onto their side.
5. Adjust the upper leg so the hip and knee are at right angles, tilt the head back to keep the airway open, and keep the hand under the cheek.
6. Monitor breathing continuously. If they stop breathing normally, roll them onto their back and start CPR.

On a boat, roll them so they face downhill if the boat is heeled, wedge them with cushions or sailbags, and keep them warm. If spinal injury is suspected, keep the head, neck and body aligned using several helpers (log roll).

Bleeding and Shock

The diagram below shows the escalation from direct pressure to tourniquet.

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1. Wearing gloves, apply direct pressure to the wound with a dressing or pad.
2. Bandage firmly over the pad. If blood soaks through, add another pad on top; do not remove the first.
3. Raising an injured limb can help, but direct pressure is what stops bleeding.
4. For catastrophic limb bleeding that direct pressure cannot control, apply a tourniquet high on the limb, roughly 5 to 7 cm above the wound (not over a joint). Tighten until bleeding stops, note the time on the casualty or tourniquet, and do not loosen it. This casualty needs evacuation.

Shock is a failure of the circulation: blood pressure too low to supply the vital organs. Signs: pale, cold, clammy skin; fast weak pulse; fast shallow breathing; thirst, anxiety, confusion, then drowsiness. Causes on a boat include bleeding (including internal bleeding from a fall), burns, severe dehydration from seasickness, heart attack and anaphylaxis. Treat the cause, lay the casualty down and raise their legs (if injuries allow), keep them warm, reassure them, and do not give food or drink. Shock is a reason to call for medical advice early.

Crush injuries from winches, anchor windlasses and fingers trapped between hull and pontoon are common. Release the trapped part, control bleeding, immobilise, elevate and monitor circulation beyond the injury. Increasing pain, swelling, numbness or a tense limb hours later can mean compartment syndrome, which requires urgent surgery.

Head and Spinal Injuries

Falls down the companionway, being hit by the boom in a gybe, and falls on deck are the classic yacht injuries. Any casualty who has been knocked unconscious, even briefly, needs medical assessment. Watch for deterioration: worsening headache, vomiting, confusion, unequal pupils, drowsiness, or clear fluid from the nose or ears. A falling level of response (AVPU) means evacuation.

For a scalp wound, which bleeds heavily, apply pressure around the edges if you suspect a skull fracture rather than pressing directly on the depression.

Suspect spinal injury after any fall from height, a heavy blow to the head, or pain in the neck or back with tingling or numbness in the limbs. Keep the casualty still in the position found unless they are in danger (fire, flooding) or you must move them to manage the airway. Hold the head in line, and use several crew to log-roll if they must be moved.

Fractures

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Signs: pain, swelling, deformity, loss of function, sometimes a grating sensation. Steps:

1. Support the limb above and below the injury.
2. Pad around the injury.
3. Splint so that the joint above and the joint below are immobilised. On a yacht, improvised splints include a rolled sailbag, a cockpit cushion, a boathook section or rolled charts. An injured arm can be immobilised with a sling and strapped to the body; an injured leg can be strapped to the good one with padding between.
4. Secure firmly, but not tightly. Check circulation beyond the injury (colour, warmth, sensation, movement) and recheck every 15 minutes because swelling increases.
5. Give pain relief from the kit if appropriate.

Open fractures (bone through the skin) need the wound covered with a sterile dressing and are an evacuation case because of infection risk. Most fractures at sea mean ending the passage or evacuating the casualty.

Burns

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Galley scalds, engine-hot surfaces, flares and rope burns are the usual causes; sunburn can also be disabling.

1. Cool the burn with cool running water for at least 20 minutes. Fresh water is best, but use clean seawater if fresh water is limited; cooling matters more than the water type.
2. Remove rings, watches and clothing near the burn unless stuck to it.
3. Cover loosely with cling film (laid on, not wrapped tightly around a limb) or a sterile non-fluffy dressing. Do not burst blisters.
4. Treat for shock; give pain relief; monitor the airway after burns to the face or smoke inhalation.

Never use butter, creams, toothpaste or ice. Seek advice for any burn larger than the casualty's hand, any full-thickness burn, any burn to the face, hands, feet, genitals or airway, and any electrical or chemical burn. Burns covering more than about 10 percent of the body are life-threatening and need evacuation.

Cold: Immersion, Cold Water Shock and Hypothermia

UK sea temperatures are typically 8 to 17 degrees C. Falling in triggers a predictable sequence, often summarised as 1-10-1:

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• 1 minute of cold water shock: a gasp reflex and uncontrolled hyperventilation. If the head is under water the gasp inhales water, which is why lifejackets and spray hoods save lives.
• 10 minutes of meaningful movement: before the muscles of the arms and hands cool and fail. This is the window to grab a line or get into a sling.
• 1 hour before unconsciousness from hypothermia in typical UK water, varying with clothing and body build.

Hypothermia

Hypothermia is a core body temperature below 35 degrees C. It also develops slowly on deck in wet, windy conditions, especially in tired or seasick crew.

Key principles:

• Rewarm slowly and passively. Insulate the whole body, including the head, and put a vapour barrier (a plastic bag or survival bag) outside dry layers. Warm (not hot) packs to the armpits and chest are acceptable; never apply heat or rub the arms and legs. Rubbing or warming the limbs opens up the peripheral circulation and sends cold, acidic blood back to the core ("afterdrop"), which can cause fatal heart rhythm problems.
• No alcohol and no hot baths.
• Recover from the water horizontally if possible (two lines, a parbuckle or a recovery sling under the back and knees). Lifting a cold casualty vertically can cause a collapse as blood pools in the legs.
• All immersion casualties need medical assessment, even if they seem fine. Water in the lungs can cause delayed breathing problems hours later.

Seasickness and Dehydration

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Seasickness is the commonest medical problem afloat and can become dangerous through dehydration, hypothermia and loss of judgement. A seasick crew member on deck is also an MOB risk: clip them on.

• Prevention: take medication before sailing (cinnarizine, or hyoscine as tablets or skin patches), as tablets are poorly absorbed once vomiting starts. Hyoscine and some antihistamines cause drowsiness and dry mouth; check for interactions and allergies.
• Practical measures: fresh air, look at the horizon, stay amidships and low, keep warm, give the casualty the helm, small dry snacks, avoid alcohol and greasy food.
• Treatment: small frequent sips of water or oral rehydration solution. Monitor urine output and colour.
• Escalation: persistent vomiting for more than about 24 hours, inability to keep fluids down, confusion or drowsiness means calling for medical advice and heading for port.

Medical Emergencies

Getting Medical Help: Coastguard and TMAS

In UK waters, call HM Coastguard on VHF Ch 16 (or by DSC urgency/distress alert, or by phone on 999 asking for the Coastguard). The Coastguard will connect you to a doctor through the Telemedical Advice Service (TMAS), and if needed will task a lifeboat or helicopter. The process is shown below.

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Choose the call category:

• MAYDAY: immediate threat to life (cardiac arrest, uncontrolled bleeding, unconsciousness, severe anaphylaxis, severe hypothermia).
• PAN-PAN: urgent medical advice or assistance but not immediately life-threatening (suspected fracture, deep laceration, stable chest pain, worsening seasickness).

Before you call, have this ready (write it down):

1. Vessel name, call sign, MMSI, position, destination and ETA, and your distance from the nearest port.
2. Casualty: age, sex, relevant medical history, medication, allergies.
3. What happened, and when.
4. Observations: level of response (AVPU), breathing rate, pulse rate, skin colour, temperature, pain level, and how they are changing. Record them every 10 to 15 minutes.
5. Treatment given so far, including any drugs with doses and times.
6. Resources on board: kit contents, crew first aid skills.

Preparing for evacuation

• Helicopter: follow instructions on Ch 16 or 67. Typically you will be asked to motor on a steady heading with the wind about 30 degrees on the port bow. Lower or secure sails if asked, clear the cockpit, secure loose gear, and stow flags and aerials if possible. The winchman or a hi-line may be lowered. Never tie the hi-line to the boat, and let the winch hook or line touch the water or the deck first to discharge static electricity. The rotor downdraught is extremely loud and strong; brief the crew on hand signals.
• Lifeboat: prepare fenders and lines, and have the casualty, their medication list and your written record ready.

The First Aid Kit and Medicine Log

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Contents should match the passage length, crew and distance from help. For coastal sailing within 20 miles of a safe haven, a kit based on the MCA Category C list (or an RYA recommended kit) is appropriate. Keep it in a waterproof container in a known, accessible place, and add a casualty record form and a pencil.

• Medication: paracetamol and ibuprofen, aspirin (300 mg dispersible), seasickness tablets, antihistamine tablets, oral rehydration sachets, antiseptic cream, sunscreen. Prescription-only items (antibiotics, strong painkillers) need a doctor's advice and must be used only on TMAS instruction. Controlled drugs such as morphine need a prescription, locked storage and a strict register.
• Wound care: sterile dressings of various sizes, adhesive plasters, wound closure strips, cling film for burns, triangular bandages, crepe bandages, a tourniquet, antiseptic wipes.
• Equipment: disposable gloves, CPR face shield or pocket mask, tick-free scissors and tweezers, thermometer, SAM splint or similar, foil survival blanket, eye wash.

Keep a medicine log recording every dose given: drug, dose, time, patient and reason. It prevents double dosing on watch changes and is invaluable to the TMAS doctor and to the hospital. Check expiry dates at the start of each season and quarterly on boats in regular use.

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Secondary Survey and Observations

Once life-threatening problems are managed (DRABC) and help is on its way or the casualty is stable, carry out a secondary survey: a calm head-to-toe check to find injuries you have not yet seen. Wear gloves, work systematically, and speak to the casualty throughout, even if they seem unconscious.

1. Ask first (SAMPLE history): Symptoms, Allergies, Medication, Past medical history, Last meal or drink, Events leading up to the incident.
2. Head and neck: scalp, ears and nose (clear fluid or blood can indicate skull fracture), pupils (equal and reacting to light), neck tenderness.
3. Chest and abdomen: pain, bruising, unequal chest movement, a rigid or distended abdomen.
4. Pelvis and limbs: tenderness, deformity, swelling, the ability to move fingers and toes, sensation and pulse beyond any injury.
5. Back: check by log rolling only if you must and have enough helpers.

Observations a doctor will want

Record these every 10 to 15 minutes on paper with the time, so trends are visible. A deteriorating trend matters more than any single number.

Count breathing and pulse over 30 seconds and double it; take the pulse at the wrist (radial) or neck (carotid). Make the observations without the casualty watching you count their breathing, as awareness changes the rate.

Man Overboard Casualty Care

A person recovered from the water is both a rescue and a medical event. Coastal Skipper candidates are expected to link MOB recovery with first aid, because the first aid begins as soon as the casualty is back aboard.

1. Recover them horizontally if you can. A rescue sling (such as a Lifesling or a horse-collar) that lifts the casualty vertically may cause collapse after prolonged immersion because venous return falls when the water pressure on the legs is removed. Use a parbuckle (a sail or net hauled across the guardrails) or a boarding platform with a second line under the arms.
2. Treat for cold water shock and hypothermia at once. Remove wet clothing if you can do so without exertion by the casualty, dry them, wrap in a sleeping bag or blankets with a vapour barrier, and cover the head.
3. Check DRABC. A casualty who has been submerged may have inhaled water; if not breathing give 5 initial rescue breaths, then 30:2.
4. Do not let them walk or work. Even a casualty who feels fine may suffer a sudden collapse in the first hour (the so-called rescue collapse).
5. Medical assessment ashore. Inhaled water can cause delayed lung problems (secondary drowning) several hours later; breathlessness, persistent coughing, drowsiness or vomiting after immersion is an emergency.
6. Afterdrop. A casualty's core temperature may fall further after rescue as cold blood from the limbs returns to the core; this is another reason to handle gently and avoid vigorous rubbing or hot baths.

For a MOB at night, use the casualty's lifejacket light, AIS beacon or PLB, and keep one crew member watching the casualty at all times while you manoeuvre.

Marine-Specific Hazards

Carbon monoxide poisoning

Carbon monoxide (CO) comes from petrol generators, gas heaters, engine exhaust leaks and BBQs used in the cockpit or cabin. It is colourless and odourless; headache, nausea, dizziness, drowsiness and collapse are common signs and can be mistaken for seasickness or tiredness. Move the casualty into fresh air, ventilate the boat, stop the source, give oxygen if available, and seek urgent medical advice. Fit a marine CO alarm in the saloon and sleeping cabins.

Electric shock

Shore power, faulty equipment and lightning are risks. Switch off the supply or disconnect the plug before touching the casualty, or use a non-conducting object to separate them from the source. Check DRABC and begin CPR if necessary. Any casualty of electric shock needs medical review because of the risk of heart rhythm problems.

Fish hooks, stings and wounds

• Fish hooks: if the barb has not passed through, back the hook out the way it went in. Otherwise cut the line, push the barb through, cut it off and withdraw the hook. Treat as a puncture wound, give tetanus advice, and seek a doctor's opinion for hooks in the face, eye or joints.
• Jellyfish and weever fish stings: rinse with seawater (not fresh water) for jellyfish; remove tentacles with tweezers or a gloved hand. For weever fish, immerse the foot in hot (as hot as the casualty can tolerate without scalding) water for 30 minutes to denature the venom. Antihistamines may reduce itching.
• Infection: wounds in a marine environment become infected quickly. Clean with clean water, cover, and watch for redness, swelling, warmth, pus or a fever.

Eye injuries

Do not rub the eye. Irrigate with clean water or sterile saline for at least 10 minutes. Cover with a clean pad (not tight) and seek advice. Anything embedded in the eye is for a doctor, not for you.

Chest and abdominal injuries

Breathing difficulty after a blow to the chest may mean broken ribs or a collapsed lung: support the casualty sitting upright leaning toward the injured side, give oxygen if available, and seek urgent help. Abdominal pain with a rigid abdomen, vomiting blood or a pale clammy collapse is an emergency.

Dislocations and sprains

Do not try to put a dislocated shoulder or finger back. Support in the position found with padding and a sling, and give pain relief. For sprains use rest, ice (cooling with a cloth between ice and skin), compression and elevation.

Skipper's Duty of Care and Passage Planning for Medical Risk

• Brief the crew on where the first aid kit is, who is the nominated first aider and how to send a MAYDAY or PAN-PAN with the DSC button.
• Carry out a pre-sail health check: record medical conditions, medication and allergies in a sealed envelope that goes with the casualty if evacuation is necessary.
• Know the nearest help. In coastal planning note the nearest port with a hospital, the nearest Coastguard station and any lifeboat station along your route; plan bale-out ports for medical emergencies.
• Do not exceed your competence. Prescription medicines should be given only on a doctor's advice (for example from TMAS), and the dose, time and the doctor's name recorded.
• Under UK law the skipper is responsible for the safety of the vessel and all persons on board, so a delay in seeking help that causes harm may be considered negligent.

Worked Example: Fall Down the Companionway

At 1600 on a passage from Dartmouth to Salcombe, in a moderate sea, a crew member slips on the companionway steps and lands on the cabin sole. He is not moving and is bleeding from a scalp wound.

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1. Danger: the skipper hands the helm to a competent crew member, asks for the boat to be put on a steady, comfortable heading under engine, and checks nothing is about to fall on the casualty.
2. Response: he does not respond to voice and only groans to a firm shoulder tap: P on AVPU.
3. Airway: suspecting a neck injury from the fall, the skipper keeps the head still and uses a jaw thrust. The mouth is clear.
4. Breathing: he is breathing normally at 16 breaths per minute. CPR is not needed.
5. Circulation: the scalp wound is bleeding heavily. A sterile pad is held firmly over it and bandaged.
6. Call: because of the head injury and reduced consciousness, the skipper has a crew member send a PAN-PAN on Ch 16 (upgrading to MAYDAY if he stops breathing). Brixham Coastguard connects TMAS. The skipper gives position (7 miles from Salcombe), patient details, mechanism, AVPU, breathing and pulse rates, and the bleeding control applied.
7. Monitoring: he is kept still with cushions packed around him, covered with a sleeping bag, and observations are written down every 10 minutes.
8. Outcome: the TMAS doctor advises evacuation because of the period of unconsciousness. A helicopter is tasked; the crew follow the Coastguard's instructions, and the casualty is lifted with a stretcher. The written record goes with him.

Worked Example: Cardiac Arrest Eight Miles Offshore

A 58-year-old crew member on a 12 m yacht complains of chest pain and then collapses in the cockpit, 8 miles south of Portland Bill, at 1130. Five crew are aboard. The skipper, Sam, is helming.

1. Danger. Sam puts the engine in neutral, heaves to and tells the nearest crew to take the helm. All are clipped on.
2. Response and Airway. The casualty does not respond; the airway is opened.
3. Breathing. No normal breathing after 10 seconds. A crew member presses the DSC distress button for 5 seconds, then gives a voice MAYDAY on Ch 16: vessel name, MMSI, position (50 degrees 22.8 minutes N, 002 degrees 26.0 minutes W), "cardiac arrest, five persons on board, require helicopter and defibrillator".
4. CPR. Two crew begin 30:2 on the cockpit sole, swapping every two minutes. A third crew member fetches the first aid kit and the pocket mask.
5. Coastguard. Solent Coastguard acknowledges within one minute and tasks the Portland lifeboat and rescue helicopter. TMAS gives instructions by voice.
6. Preparation for helicopter. One crew member prepares a written note with name, age, medication list and time of collapse. Sails are lowered and the boat motors into the wind at about 5 knots as instructed.
7. Handover. The paramedic takes over CPR, the casualty is winched and the notes and timeline go with him.

What the examiner wants to hear. Danger first, rapid recognition, alert early (cardiac arrest is a MAYDAY), continuous CPR with rotation, written details, and the skipper managing the whole boat while the crew treat the casualty.

Exam and Practical Tips

• Talk through DRABC out loud in the practical exam: examiners want to hear the order and the reason.
• Know exactly what is in your kit and where it is stowed.
• Be able to explain the difference between a MAYDAY and a PAN-PAN medical call, and give the information the Coastguard will want.
• Know what helicopter hi-line and winching mean in practice: do not touch the winch wire or cable until it has earthed on the deck or in the water, and never attach it to the boat.
• Revise your first aid certificate expiry dates: an out-of-date certificate means you cannot sit the exam.

Common Mistakes

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• Rubbing or actively warming a hypothermic casualty's limbs. Rewarm the core passively and slowly.
• Assuming a near-drowning casualty who now "seems fine" is fine. All immersion casualties need medical evaluation.
• Butter, ice or creams on burns. Use cool water for 20 minutes and cling film.
• Delaying the call for advice. Call early; the Coastguard would rather give advice that turns out not to be needed than mount a rescue in the dark later.
• Not logging drugs and observations. Records prevent overdose and help the doctor.
• Moving a suspected spinal injury unnecessarily. Move only if there is immediate danger, and then as a team keeping the spine aligned.
• The skipper becoming the only first aider. If the skipper is the casualty, someone else must be able to call for help and treat.

Summary

• DRABC is the start of every assessment; make the boat safe first.
• CPR is 30:2 at 100 to 120 per minute and 5 to 6 cm deep; give 5 initial breaths for drowning; brace against the motion.
• Unconscious and breathing: recovery position and constant monitoring.
• Direct pressure controls most bleeding; tourniquet for catastrophic limb bleeding. Treat shock by laying flat, legs raised, warm.
• Cold water: 1 minute shock, 10 minutes useful movement, about 1 hour to unconsciousness. Rewarm hypothermia passively, recover horizontally, and always get immersion casualties assessed.
• Seasickness is prevented with early medication and managed by rehydration; escalate if fluids cannot be kept down.
• Get medical advice through HM Coastguard and TMAS early, with written observations ready. Know how to prepare for a helicopter.
• Keep a suitable kit and a medicine log.

Check Your Understanding

1. What does DRABC stand for, and what is the first priority on a yacht?

Answer: Danger, Response, Airway, Breathing, Circulation. The first priority is making the boat and rescuers safe, for example handing over the helm and stopping or slowing the boat.

1. How does CPR for a drowning casualty differ from standard adult CPR?

Answer: Give 5 initial rescue breaths before starting cycles of 30 compressions to 2 breaths, because the cause is lack of oxygen.

1. Why must you not rub the arms and legs of a hypothermic casualty?

Answer: It dilates the peripheral blood vessels and returns cold, acidic blood to the core (afterdrop), which can cause fatal heart rhythm disturbances.

1. What are the three phases of the 1-10-1 principle?

Answer: About 1 minute of cold water shock (gasp reflex and hyperventilation), about 10 minutes of meaningful movement before the limbs fail, and about 1 hour before unconsciousness from hypothermia.

1. How long should a burn be cooled, and what should it be covered with?

Answer: At least 20 minutes with cool running water (seawater if necessary), then covered loosely with cling film or a sterile non-fluffy dressing.

1. A crew member is in the recovery position; describe how to place the arms before rolling.

Answer: The near arm goes out at right angles with the elbow bent and palm up; the far arm comes across the chest with the back of the hand held against the near cheek. Then lift the far knee and roll them towards you.

1. How do you obtain medical advice at sea in UK waters?

Answer: Call HM Coastguard on VHF Ch 16 (or by DSC alert, or 999 by phone). They connect you to a doctor through the Telemedical Advice Service (TMAS) and arrange evacuation if needed.

1. What information should you have ready before calling for medical advice?

Answer: Vessel details and position; casualty age, sex, history, medication and allergies; what happened and when; observations such as AVPU, breathing, pulse and colour with trends; treatment and drugs given; resources on board.

1. During a helicopter evacuation, why must you never tie the hi-line to the boat?

Answer: The helicopter could be pulled down or the boat damaged if the aircraft has to move away suddenly. The line is held by hand only, after it has touched the water or deck to discharge static.

1. What should you record in the medicine log?

Answer: Every dose: the drug, dose, time, patient and reason.

1. What does SAMPLE stand for in a secondary survey, and why is it useful in a call to TMAS?

Answer: Symptoms, Allergies, Medication, Past medical history, Last meal or drink, Events. It gives the doctor a structured summary of the casualty so that advice is relevant and safe.

1. Why should a casualty be recovered horizontally from the water after a long immersion, and what delayed risks must you watch for after recovery?

Answer: Vertical lifting removes the water pressure on the legs and can cause blood to pool in the legs, which may lead to cardiac collapse. After recovery watch for hypothermia and afterdrop, and for delayed lung problems from inhaled water (breathlessness, coughing, drowsiness, vomiting); all immersion casualties need medical assessment.

1. A crew member develops a headache, nausea and drowsiness in the cabin while the gas heater is running. What do you suspect and what do you do?

Answer: Carbon monoxide poisoning, which can mimic seasickness. Move everyone into fresh air, ventilate, shut off the source, give oxygen if available, and call for urgent medical advice. Fit a CO alarm.