When sailing offshore, the first aid dynamics are very different.
On land, a serious injury can often be handed over to paramedics within minutes. Offshore, you may be responsible for an injured crew member for hours, and in our case days. The yacht is moving, conditions can deteriorate, medical facilities may be hundreds of nautical miles away and a helicopter or rescue vessel, are unlikely to be able to reach you.
That is why we believe offshore sailors should have Marine-specific First Aid Training, appropriate medical equipment and a reliable way to obtain professional medical advice.
We have first-hand experience of such a medical event, two days offshore and three days to land. During a passage from Australia to New Caledonia, I suffered a serious burn in confused seas. What initially appeared manageable eventually required hospital treatment in New Caledonia and a flight back to Australia.
The incident highlighted and reinforced the values of correct medical preparation aboard our yacht.
A standard first aid qualification provides essential skills. CPR, bleeding control, burns, fractures, shock and other emergency procedures are relevant wherever you are.
The problem offshore is the environment in which those skills have to be applied.You may be treating someone:
> On a moving yacht,
> In heavy weather,
> At night,
> In a confined space,
> Without immediate access to an ambulance,
> Many hours or days from professional medical care,
> While other crew continue to manage the vessel, and
> With limited water, power and medical supplies.
The Royal Yachting Association recognises that first aid at sea presents different circumstances from first aid on land. Its marine first aid training includes subjects such as drowning, hypothermia, head injuries, bleeding, first aid kits and obtaining medical assistance by marine radio.
Australian maritime guidance also recognises the need for medical skills appropriate to conditions aboard vessels, including treatment of fractures, dislocations, head and spinal injuries, burns, drowning, resuscitation and splinting. This falls under Regulatory Requirement (duty-of-care) for the ships.
A current general first aid certificate does not qualify a person sufficiently to deal with the practical problems associated with a serious injury offshore.
For us, marine first aid is part of offshore passage preparation.
We did not learn this lesson from a textbook.
We were sailing from Australia towards New Caledonia. The sea had a 2–3 metre swell and the wind had previously been around 20 knots, gusting to 25 knots. It had eased, but we were still sailing at around 7–9 knots with two reefs in the mainsail and the genoa partially furled.
I was on watch when I went into the saloon to make a lemon and ginger tea. We already had an offshore rule that hot drinks stayed in the sink while underway. The cooktop, oven and microwave were also off limits when conditions were rough.
The kettle and cup were in the sink. It still went wrong.
To read the full story, click this link.
The 3rd degree Burn Became More Serious
After arriving in New Caledonia, we continued treating the injury. Once we reached Îlot Maître, we were able to obtain further assistance and used the Flamazine following further medical advice. You would not locate Flamazine in a standard first aid kit, yet alone have sufficient training information to protect and dress the wounds.
The bottom line identified two third-degree burns, an area of second-degree burn and surrounding first-degree burns. Surgery and a skin graft was required.
What the Incident Taught Us
1. We already carried an Offshore appropriate First Aid Kit.
2. We already had marine first aid training.
3. We already had solid communication channels that worked.
The biggest lesson was that the kit needs to be designed around the consequences of being remote, rather than around what fits conveniently into a small first aid box.
Our kit is an approved Marine Cat1 First Aid Kit. After the burn incident, we increased the quantities of several items. For example:
> Non-stick gauze dressings increased from 4 to 20
> Gauze bandage rolls increased from 4 to 15
> Burn gel dressings increased from 1 to 2
The purpose was not to turn LIBERTY2 into a floating hospital. It was to make sure we could continue treating an injury when professional medical care was not immediately available.
AMSA takes a similar risk-based approach. Its guidance states that medical and first aid equipment should take account of factors such as the distance and time to medical assistance, voyage length, communications, environmental conditions, likely hazards and the training of the crew.
Our medical equipment has evolved through experience, training and the type of cruising we undertake. The offshore medical kit includes conventional Cat 1 First Aid Supplies (as written in the Australian Special Regulations - Part 1), along with equipment specifically selected for more serious situations. We do understand that we are not racing, this however is the closest guidelines that are available within Australia, for Australian registered vessels heading to Remote and/or Offshore destinations.
To this kit, we have added additional equipment that includes:
> Blood pressure monitor
> Automated external defibrillator, or AED
> Inflatable splints (pack of 6 for various body parts
> Emergency Dental first aid package
> Burn gel dressings
> Non-stick wound dressings
> Gauze and bandages
> Burn treatment products
> Wound closure and dressing supplies
> CPR equipment
> Trauma and bleeding supplies
> Thermometer
> Pulse oximeter
> Blood Pressure Monitor
> Other diagnostic and treatment equipment
> Marine medical reference manuals
AMSA recommends assessing the risks of the voyage when determining the appropriate medical and first aid equipment to carry. They also recognises the importance of communications when considering medical preparedness aboard vessels. A vessel operating remotely needs the ability to seek assistance and communicate relevant information about a casualty and the vessel's situation.
This link will take you to our 🏥 Medical Kit Checklist
We have completed marine-specific first aid training with Heart Training, and I have personally completed their courses four times. Their Marine First Aid course combines nationally recognised:
* HLTAID009 Provide Cardiopulmonary Resuscitation
* HLTAID011 Provide First Aid
* HLTAID013 Provide First Aid in a Remote or Isolated Site
Their courses address situations relevant to marine and remote environments, including severe burns and bleeding, CPR and defibrillation, fractures, spinal injuries, hypothermia, dehydration, marine bites and stings, patient evacuation and obtaining medical assistance. In fact, they will actually do training on your vessel, which is an eye-opener, especially when dealing with an incapacitated crew in confined space. Try do CPR in a corridor.
The RYA makes a practical observation. During a serious incident at sea, it can be difficult for one person to navigate, operate the vessel, communicate with rescue services and provide treatment simultaneously.
That is why first aid preparation is a crew responsibility, not simply a skipper's responsibility. Everyone Aboard Should Know the Basics.
Medical Disclaimer
This article describes our personal offshore preparation and experience. It is not medical advice and should not be used as a substitute for professional medical treatment or current first aid training.
First aid procedures, medications and medical equipment should be selected and used according to current Australian Resuscitation Council guidance, qualified training, manufacturer's instructions and professional medical advice.
The contents of an offshore medical kit should be based on a risk assessment that considers the vessel, crew, destination, voyage duration, environmental conditions and access to professional medical assistance. AMSA provides guidance on medical and first aid equipment for Australian vessels.