Medical Emergencies On Your Boat
By Ann Dermody
One minute everything's fine aboard, and then someone has an accident and everything goes to hell. Think about how you'd handle it.
TowBoatUS Captain Kevin Freestone and his wife Lisa's late afternoon was panning out like most others. A perfect, blue-skied 80-degree October day, in the lower Florida Keys. The VHF radio was crackling with the usual chatter between boats, marinas, fishermen, and the Coast Guard, and Lisa was about to start dinner. Then, right at the same time as Kevin's volunteer firefighter pager started to go off, a call came over the VHF telling Freestone that two kayakers in the mangroves needed his help. Quickly.
Photo by Onne van der Wal
What the calls didn't say was that less than five miles away, Karri Larson was clinging to life. She and her boyfriend, Michael Hinojosa, had been paddling their two-person kayak through the backcountry, enjoying the water and wildlife, marveling at a barracuda that jumped twice through the water then disappeared. When the fish leaped a third time, it slammed straight into Larson at 35 miles an hour, impaling her left side, and propelling her out of the boat with sheer force.
"When I looked at her, I saw this big hole in her back," Hinojosa recently recalled. "Her lung was popping out of her ribs and my initial thought was, 'there's no way she's going to survive this. She has moments to live.'"
Larson, who'd worked as an EMT for eight years, knew how serious the situation was, too. "As soon as I heard the gurgle, I knew I'd a punctured lung. There's something called the 'golden hour' where, with certain injuries such as a sucking chest wound, you get an hour. Then there's a three-percent chance of survival."
Time was already ticking and the rescue was complicated further by the fact that neither 911 nor the Coast Guard had a flats boat to get to Larson. That's where Kevin Freestone came in. When Freestone called Hinojosa's cell phone, Michael Hinojosa told him: "Today's the day you need to save a life. She's dying in my arms." Within seconds Freestone figured out where the kayakers were and headed out in his TowBoat. Lisa set out in their flats boat, knowing it was the only way her husband would be able to get into the shallows. They quickly got the couple to land, where Larson was airlifted to Ryder Trauma Center in Miami. After several days in ICU, she's been making a slow recovery.
Though theirs is a dramatic and unusual example of someone becoming disabled on the water, rendering yourself or one of your crewmembers incapacitated can have far-reaching and, if ill-prepared, sometimes fatal results. According to a recent online survey of 1,188 respondents by the Wilderness & Environmental Medicine Journal, the most common medical emergencies on sailboats were leg bruises (11 percent), hand lacerations (eight percent), and arm bruises (six percent). The most frequent causes of injury were tripping and falling, being hit by an object, or being caught in lines. Tacking, heavy weather, and jibing were also cited in most of the incidents. Of the 70 severe injuries reported in the survey, 25 percent were fractures; 16 percent torn tendons or cartilage; and 14 percent were concussions.
Dr. Mark Anderson is an emergency-medicine doctor and boating enthusiast of several decades in Washington State. He owns several vessels, including a 40-foot ketch he's building. He's had a longstanding interest in medical emergencies on recreational boats after being asked for advice regarding a cruising medical kit in a chat room several years ago. He started a website (www.riparia.org) to give some basic knowledge to boaters physically isolated from access to professional medical care — particularly useful for long-haul cruisers.
Yikes! A toothy missile like this one struck Karri Larson, turning an idyllic outing into a life-threatening emergency. Photo credit: Pat Ford
But even day-sailors, he says, can prepare themselves for the worst. The top things he recommends to have aboard are bandages for lacerations; some sort of splint for breaks and sprains (the padded flexible ones are particularly good, he says); non-prescription seasickness pills; aspirin for potential heart attacks; antacids for digestive upsets; an antihistamine such as Benadryl for seasonal allergies; and a painkiller such as Tylenol. Aloe vera for burns and blisters is another staple in several onboard medical kits.
Lacerations, one of the most common injuries onboard, can usually be stopped by applying direct pressure for 10-15 minutes. "Don't stop and don't peek," Anderson advises. "If you think something needs suturing, you've got about six hours, otherwise the infection risk goes up. Most wounds are only closed to reduce the risk of infection, speed healing, and reduce scarring, but virtually any wound will heal on its own given time."
For long-term cruising, Anderson suggests working with your physician to establish what you might need and get prescriptions. "Even if you have knowledge, unless you have some basic supplies, you can't do much. The most useful thing you have is your radio," he says, recalling a call he heard to the Coast Guard by a distressed mother some years ago. "She was calling, 'Coast Guard, Coast Guard, my son's just put sunflower seeds up his nose!' She was totally panicked and it was amazing how quickly they got a doctor on the radio that told her to get some pepper to sneeze them out. Which he did!"
Calling the Coast Guard in any medical emergency you deem yourself unfit to handle is always a good idea. "Anytime there's a medical emergency that the boater feels is an immediate life-threatening situation, it's appropriate to call mayday to contact the Coast Guard," says Captain David McBride of the USCG Office of Search & Rescue. "If the situation is not immediately life-threatening, but is still beyond the capability of those on the boat, they should simply hail the Coast Guard and request medical advice, also known as a medico."
Once you call the Coast Guard, be prepared to give a laundry list of information about the emergency. They'll then assess whether the need is for medical advice, or a complete medevac (where the Coast Guard removes the injured party).
"Medical evacuations can be extremely hazardous to both the patient and crew for a variety of reasons," says McBride. "In all medevac operations, the risk of the mission will be weighed against the risks to the patient."
But that's all in response to a very extreme situation that most boaters, luckily, will never come close to encountering. For advice and reassurance for an onboard injury or medical situation you think you can't handle, get on the radio and hail the Coast Guard to request a medico.
There is also an international organization C.I.R.M. that provides free medical advice to vessels (www.cirm.it) that can be reached via cell or satellite phone.
Ann Dermody is managing editor of BoatUS Magazine.
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