Medical Emergency Readiness (Work in Progress)

[Foswick]

As part of a presentation on onboar medical emergency readiness, I have been working on a handout. The purpose is to give a list of topics and equipment to consider to evaluate one's own readiness. This isn't meant to be a list of "you must do everything on this list", but a list of "you should think about these things and evaluate whether your have addressed them or need to."

This is very much a work-in-progress and it is still pretty tied to the presentation that explains a few of these items in ways that this checklist leaves ambiguous. And, the resources section pretty much just has placeholders, right now. But, I would still be keen to get feedback/questions:

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Medical Emergency Readiness – Season Checklist
Review this annually to prepare for the boating season. Use it to identify training needs, update equipment, and plan for your crew's specific risks.

Talk about expectations with your crew. Whether you have a DNR or other formal directive, make sure everyone is on the same page about care expectations. Don’t let your crew wonder if they’ve done enough for you.

Crew Skills and Knowledge
Do at least two people on board know how to:

• Control the boat solo (in case the skipper is incapacitated)
• Perform a 30-second rapid assessment (AVPU and ABCD)
• Use the VHF, including DSC distress functions
• Locate and report lat/long coordinates
• Recognize heart attack symptoms
• Recognize stroke symptoms (e.g., F.A.S.T.)
• Administer aspirin to a suspected heart attack victim
• Perform compression-only CPR
• Perform rescue breathing (if gear and crew permit)
• Check and establish an airway
• Administer emergency meds (e.g., EpiPen, nitroglycerin)
• Control major bleeding
• Recognize and manage hypothermia
• Recognized and manage heat stroke
• Treat serious burns
• Apply or improvise a neck collar

Crew-Specific Medical Concerns
Does anyone have any of the following? Does at least one other crew member know about special considerations? Is this documented, on board, if appropriate? Where?

Tell EMS about all of these, when they arrive:

• Diabetes (glucose/insulin)
• Blood thinners (increased bleeding risk)
• Severe allergies (EpiPen)
• Seizures (What type? Triggers? Normal recovery?)
• Cardiac history or implanted devices
• Beta blockers
• Other medical condition
• Other medications
• DNR or advanced directive

Equipment and Supplies
Do you have or need these and are they in good shape and not expired?

• DSC VHF
• AED (pads and battery)
• PPE (gloves, mask, eye protection)
• CPR mask and/or bag-valve mask
• Pulse oximeter
• Trauma dressing
• Hemostatic agent (QuikClot, e.g.)
• C-collar or improvised horse collar
• Aspirin (81 mg)
• Thermometer (battery check)
• Trauma shears
• Medical tape (3M Transpore)
• Glucometer (glucose paste)
• Blood pressure cuff (stethoscope)
• EpiPen
• Narcan
• Crew-specific meds

Resources

• USCG District 13 Local Notice to Mariners: https://www.navcen.uscg.gov/sites/default/files/pdf/lnms/LNM13502024.pdf
• AHA Up-To-Date CPR Discussion: What is CPR
• Raritan Yacht Club – Medicine and First Aid for Offshore Sailors:

 

[Foswick]

Here is the updated resources section:


Resources

• USCG District 13 Local Notice to Mariners – Discusses the Coast Guards response guidelines in our region. (https://www.navcen.uscg.gov/sites/default/files/pdf/lnms/LNM13502024.pdf)

• American Red Cross – First Aid/CPR Training & Resources – Offers first aid and CPR/AED courses (online or in-person) and provides online guides for handling common emergencies. The Red Cross site covers maritime-relevant first aid topics like treating hypothermia, heat stroke, severe allergic reactions, and more. (Red Cross Training | Take a Class | Red Cross)
• American Sailing Association – “Handling Medical Emergencies at Sea” – A 90-minute online course focused on first aid training for boaters. It teaches how to handle medical issues in a sailing/cruising environment, covering necessary equipment, emergency decision-making, and offshore medicine techniques. (Handling Medical Emergencies at Sea)
• American Heart Association – Heart Attack & Stroke Signs – Official AHA guidance on recognizing heart attack and stroke symptoms and responding quickly. Explains warning signs (like chest pain or FAST test for stroke) and emphasizes immediate action (calling EMS and starting CPR) for these life-threatening emergencies. (Heart Attack, Stroke and Cardiac Arrest Symptoms)
• American Red Cross – Severe Allergic Reaction (Anaphylaxis) First Aid – Describes how to recognize anaphylaxis (life-threatening allergic reaction) and what to do. Includes first aid steps such as using an epinephrine auto-injector (EpiPen) if available, calling EMS, and treating for shock while waiting for emergency help. (Allergic Reaction/Anaphylaxis: Causes, Symptoms, How To Help | Red Cross)
• CDC – Hypothermia & Heat-Related Illness Guidance –Provides tips on preventing, recognizing, and first-aid treatment of hypothermia (dangerous cold exposure, common in cold water boating) and heat stroke or heat exhaustion (caused by extreme heat). It outlines warning signs (shivering, confusion, or, conversely, high body temperature and dizziness) and first aid measures to stabilize the person until help arrives. (Preventing Hypothermia and related pages on heat emergencies)
• CDC “Stop Overdose” – Naloxone (Narcan) Use – Explains how to respond to an opioid overdose using naloxone. This CDC resource describes where to get naloxone and how to safely administer it (nasal spray or injection) to reverse an overdose. It’s a useful guide for carrying and using Narcan on board in case of an opioid emergency. (Lifesaving Naloxone)
• “Stop the Bleed” Campaign (ACS/DHS) – A national program teaching the public how to control severe bleeding in an emergency (such as a serious cut or trauma on board). The official Stop the Bleed site offers simple instructions on using direct pressure, packing a wound, and applying a tourniquet to stop life-threatening bleeding, as well as information on training classes and bleeding control kits. (STB Home Page)
• Maritime Good Samaritan Law (U.S.) – Overview of U.S. laws protecting boaters who render aid. Explains that federal law (46 U.S.C. §2304) requires vessel operators to assist anyone in danger at sea if they can do so safely, and Good Samaritan provisions (46 U.S.C. §2303) shield those who help from liability as long as they act as an ordinary prudent person would. (The Good Samaritan – Safety of Life at Sea | Waterway Guide
• Advance Directives (DNR Orders) in Emergencies – General medical guidance on upholding Do Not Resuscitate (DNR) orders or advance healthcare directives. This resource explains what DNR means, how it’s documented, and how it guides responders in an emergency. It’s useful for understanding how such directives might apply if a boater has a DNR – essentially informing crew or rescuers about the person’s wishes regarding CPR or other life-saving measures. (Do-not-resuscitate order: MedlinePlus Medical Encyclopedia)
• BoatUS – On-Board First Aid Kit Essentials – A practical guide listing some of what to include in your boat’s first aid kit – from bandages, antiseptics, and medications (e.g., aspirin for potential heart attack) to tools like scissors, tweezers, gloves, and a first aid manual. This checklist has very little that would save a life, but it is a good start to a well-prepared kit. (https://www.boatus.com/expert-advic...essential-on-board-first-aid-kit-for-any-boat)

• Raritan Yacht Club – Medicine and First Aid for Offshore Sailors – About an hour-long video interview of Gary B. Nackman M.D. an offshore sailor with over 15,000 Bluewater nautical miles & 30 plus years of medical experience. Well worth the watch.
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[pgandw]

I live in a completely different world. Sailing solo, most important is no unintended exits from the boat. If the worst happens, I need to be wearing a PFD equipped with strobe and PLB. From the water, operation of even a waterproof VHF handheld is problematic, to say the least. Ideally, my hat would have Velcro to hold the PLB and/or strobe out of the water.

As for medical, a good first aid kit to enable me to fix minor and major cuts is about the best I'll be able to do. Heart attack or stroke require me to get off the emergency call before I succumb. Not likely, but possible.

Need to carry sufficient water and sunscreen for a cruise. For a guy on a low sodium diet, food choices beyond the first two days suck.

Of course, I'm not making open ocean passages, either. Reality is that sailing solo has risks, more so if there are not other boats with you. Read the openers for the raid-style events for smaller boats.

If I'm going to go, I can think of worse times/places to go than sailing. Select safety gear that makes sense for your style of sailing.

Fred W
Stuart Mariner 19 #4133, Sweet P

 

[Foswick]

I live in a completely different world. Sailing solo [...]

Yeah, solo is a different ball game. This is actually geared toward a fairly specific demographic: coastal cruisers (with a target rescue time of around an hour), mostly couples, where the average age is probably around 70 years. (Though, it is generally useful for non-solo cruisers that can expect to be roughly an hour or so from rescue.) One of the principles is that, to properly manage a medical emergency, you need to leave the dock with at least three capable people. And, you only have two, and one of them is the patient. So, the emphasis is on what you can and can't reasonably/safely do, and being at peace with that.

Solo sailing, beyond just staying on the boat, definitely the most valuable piece of equipment is the distresss button on the DSC VHF. If you have a truly life-threatening medical emergency, even with two people on board, the odds are not great. Solo, the distress button might be your only chance.

I have never heard of anyone having a heart attack or stroke (for example), activating the DSC, and being rescued ... but what a story that would make! I would love it if someone did know of such an incident. If I have to make it up, it will involve sea serpents and pirates.

Ironically, for solo sailors, diagnostic tools like a BP cuff, thermometer, and glucometer (if needed) become even more valuable. When you are feeling "off" it can give you some objective information and inform you about what to do, especially since you might not be thinking completely clearly.

(I had actually removed the thermometer from my list of recommended equipment because I was thinking about it only for hypothermia and, in most such cases, getting a reliable temperature non-rectally is pretty unreliable. But, one of the ER docs I consulted - an offshore racer - pointed out that we see a lot of older adults who chose to "power through" a high temperature. The risk there, of course, is sepsis, which can come on without a lot of warning and kill in a matter of hours. And, it tends to come with a state of confusion. So, having that hard number might be the thing that saves your life.)

But, you hit it on the head. You have to know your own risk profile and tolerance. That's why this is presented as a list of things to consider, each season. It doesn't mean you need to, for example, carry an EpiPen. But, it does remind you to think about this and make sure that, if you do, someone other than you knows how to use it.

 

[pgandw]

Yeah, solo is a different ball game....
Solo sailing, beyond just staying on the boat, definitely the most valuable piece of equipment is the distresss button on the DSC VHF. If you have a truly life-threatening medical emergency, even with two people on board, the odds are not great. Solo, the distress button might be your only chance.

I have never heard of anyone having a heart attack or stroke (for example), activating the DSC, and being rescued ... but what a story that would make! I would love it if someone did know of such an incident. If I have to make it up, it will involve sea serpents and pirates.

Ironically, for solo sailors, diagnostic tools like a BP cuff, thermometer, and glucometer (if needed) become even more valuable. When you are feeling "off" it can give you some objective information and inform you about what to do, especially since you might not be thinking completely clearly.

But, you hit it on the head. You have to know your own risk profile and tolerance. That's why this is presented as a list of things to consider, each season. It doesn't mean you need to, for example, carry an EpiPen. But, it does remind you to think about this and make sure that, if you do, someone other than you knows how to use it.

Agree with most of what you say. I left the CG before DSC became widespread other than commercial shipping. On a solo small boat, a fixed VHF is pretty worthless - it can't be in the cockpit with me, and protecting the antenna when I trailer is yet another chore. I use a cheapy handheld (no DSC) due to sometimes being in waters without VHF-FM coverage. The VHF-FM serves as comms when I sail with other boats, and to get bridges open. Otherwise, cell phone suffices.

I do take my BP (and weight) daily due to an episode of congestive heart failure, and that would probably be important when cruising to catch the sodium and water levels climbing and detect the irregular pulse of afib, since weighing myself on the water is not all that practical. Hence my comment about lack of low sodium food when refrigeration runs out.

Something to consider - when I was flying rescue ('78-'93), we had verbal guidance NOT to hoist a heart attack victim if we could avoid it. The thinking was that the trauma of the hoist would send most heart attack victims over the edge. With the advent of rescue swimmers ('91), the swimmer (paramedic in addition to swimmer) can often partially stabilize the patient before the hoist, so guidance may have changed.

In case you are wondering, in '96 I was diagnosed with a bicuspid aortic valve that had gone undetected in all my flight physicals until then. As my cardiologist says, I screwed the government for 16 years of flying I was never supposed to have.

Fred W
Stuart (ODay) Mariner 19 #4133 Sweet P

 

[Foswick]

Great contribution, Fred!

It is a good question about moving MI patients. I do not know what the current guidelines are. I would be surprised if they did not emphasize the most rapid mobilization possible, since that has been the general trend, but I do not know. That is a good follow-up question to add to my list. Did this guideline apply to known MI or suspected?

A lot of context comes to mind that makes this a potentially tricky call. The most obvious being how safe it is to get medics and equipment on the boat and treat the patient in situ. If that was safe to do, I don't see how it would be any different than any other ACLS call (aside from the obvious differences). If this wasn't safe, I guess that falls under the heading of "if we could avoid it".

But, this is where it gets outside of my expertise. If you could not (or did not want to) hoist, how would you transport? Would you just wait until you got a rescue boat alongside? Or, are you saying that you would just not transport unless you had to?

I guess I need to go talk to the USGG about rescue, and not just specifically medical questions. I know actually very little about their rescue protocols, beyond expected respond times and personnel training as it pertains to medical emergencies. The goal is to organize a larger community event (a sort of weekend "safety fair") possibly next spring, and the local USCG and Aux will be invited to participate and contribute. (This is very much still in the idea phase, but so far, the interest has been encouraging.)

My direct experience of such things is limited to the interactions I had with the AirLift crews, working in the ER. And, that only gave me a vague sense of what they did outside of specifically medical interventions.

 

[pgandw]

It was a verbal, passed down from senior pilots, but made sense. Hoists are quite traumatic, with victim spinning while being hoisted into a very loud, very strong downdraft. There was no guidance in writing that I ever saw. Almost every CG rescue is conducted at the discretion of the pilot or coxswain because there is no way to know how things are going except for those actually on scene. The written rescue guidance at the time allowed you (aircraft commander or coxswain) to risk the crew's lives to save lives. You could risk the aircraft or boat to save property.

In the mid '80s it was discovered that the CG had a worse safety record with helicopters than any other service. Boat crew losses were high, too. The worst part was that in every case where a CG helicopter crashed and killed the crew before getting on scene, the intended rescuees survived not being rescued. This was true from the '50s to the '80s. Of the 30 CG pilots I went through flight school with, 6 died in aircraft accidents. The attitude was, "you have to go out, but you don't have to come back." for helicopters and small boats alike. New guidance emphasized the need to bring your crew back alive to fight another day.

The 1st time I encountered the don't hoist heart attacks was as a junior copilot on Thanksgiving 1978, long before rescue swimmers. 35ft sailboat in the Gulf Stream, sailed by a couple. She had radioed for help, saying he had had a heart attack. We found the boat, main had been partially lowered, but the boat was still over powered. My aircraft commander was in a very foul mood, having had his Thanksgiving dinner at the base interrupted. He had no mercy on her, telling her we couldn't hoist him as a heart attack victim and a couple of other things. It was too rough to send a small boat crew out, and they would have had a very difficult time transferring the victim. Your guidance and running through scenarios might have resulted in a much better ending.

I knew the correct thing to do was to lower me - the useless copilot - onto the boat where she and I could have probably gotten the boat safely to Palm Beach, FL in about 3 hours. But I was too scared to insist on the right answer. Never heard from or saw the boat or the couple again. That one tears my heart out every time I remember it. When I stand before the Lord on Judgment Day, I'm sure the memory will come back again. The Lord will say to me, "I gave you the skills and the knowledge to save them, but you failed to do so." And I will just stand there and bawl.

That said, most of the CG are not good sailors. They are very good at handling power boats and aircraft, but they know little about sailboats and sailing. They would not be able to get that boat into port in the rough wx. The aircraft commander had no way of knowing that I was a very capable sailor.

I think your suggested meetings are very appropriate and would be welcomed by both CG and CG Aux.

Fred W
Stuart (ODay) Mariner 19 #4133 Sweet P