Valley Squadron

Preparing for Boating Medical Emergencies
By Jim Thompson
jim.thompson@blueheroncps.pe.ca

In my years as an emergency physician and longer years as a sailor, I have seen very few medical emergencies on boats, major or minor. But they can happen, and they are always unexpected. Fortunately serious medical emergencies are extremely rare among boaters in PEI’s waters. Minor problems occur occasionally. As with everything about the sea, boaters need to be prepared ahead of time. Help is not immediately available the way it is on land.

Disclaimer: This article is an informal guide to help local boaters prepare for medical problems during day and overnight trips in our local waters. Prince Edward Island is a province on the Atlantic coast of Canada in the Gulf of St. Lawrence. I have not tried to cover offshore cruising. Talk to your doctor about preparing for specific medical problems. Take a Red Cross First Aid course. Learn CPR (cardiopulmonary resuscitation).

Prevention is Everything

There is no such thing as an “accident” because every such event ultimately is preventable.


	Wear a PFD (personal flotation device).
	Do not go to sea if you have a medical condition that might get you and others into serious trouble.
	Keep track of pets, kids and guests who might fall off the boat.
	Brief guests on safety issues before leaving the dock.
	Practice man overboard (MOB) and other standard boating safety techniques with your crew. Be especially careful to train the crew about docking and undocking, and handling lines.
	File a float plan with Sydney Coast Guard Radio before departure. Call on a VHF radio, or use a cellphone to call using *16, 800-686-8876, or (902) 566-8803.
	Learn how to access marine weather forecasts.
	Alcohol impairs judgment severely, even in small quantities. Alcohol, fatigue, summer heat, mild dehydration and mild seasickness can be a deadly combination.
	Install a carbon monoxide detector.
	Consider a smoke detector too.
	Avoid dehydration, hunger, fatigue and sun exposure.
	Take the Canadian Power & Sail Squadron Boating course to learn good seamanship practices, and then carry on to take more CPS courses (see VHF License). You can never know enough about the sea.
	Obtain a VHF radio, and take the 1-day CPS Radio Talk course to become licensed to use it.

Serious Emergencies Unique to Boating

The most serious threats to boaters in our waters are drowning or near drowning, hypothermia, carbon monoxide poisoning, and major trauma from falling.

Minor Health Problems Unique to Boating

Seasickness, heat illness, sunburn, skin burns from hot machinery, and bone or soft tissue injuries from falls seem to be the most common minor medical emergencies on boats around PEI.

Jellyfish. The common red (Lion's Mane or Purple jelly, Cyanea capillata) and more common white (moon jelly, Aurelia aurita) jellyfish in our waters are not a problem for most people. A few people seem to get a bit of an itchy rash that goes away in a few hours and is easy to treat with cool water rinse, Tylenol and Benadryl. I have never seen a jellyfish sting in our Emergency Department.

Do not swim in marinas and harbors. Sewage contamination is common in Canadian waterways, especially seawater.

General Health Problems

People with no health issues can suffer at sea from all the usual human ailments: headaches, colds, flu, diarrhea, allergies, appendicitis, skin infections, sprained ankles, toothaches, hangovers and the like.

People with known health problems who are used to managing themselves on land must think carefully before getting on a boat, if they do at all. They need to bring their medications (e.g. nitroglycerine, insulin, inhalers, and other prescriptions) and health care devices (e.g. chemstrips, aerochambers, splints, etc). Pack them in a special bag to have everything handy in one place. Bring doctors’ phone numbers and a written record to show to a new doctor if they have to go to an Emergency Department. Patients and parents should visit with their doctor before leaving on a cruise to make sure their condition is stable and everything has been anticipated as much as possible. Talk to the doctor to learn when to recognize a developing problem before it becomes an emergency. Think very carefully about what you would do in every eventuality.

Getting Help in Emergencies

Boaters on the water can’t simply call an ambulance or drive to the doctor’s office as they can on land. Getting medical help on the water takes special knowledge and advance preparation.

Do not assume that rescue vessels can appear beside your boat in minutes, or that a helicopter will appear overhead to pluck your patient into the sky. The Coast Guard auxiliary system is comprised mostly of displacement fishing boats that will have to travel from a nearby port, if they are not already at sea somewhere else. Coast Guard inshore rescue RIBs can cover a lot of local distance in a short time, but they are only deployed in a few larger communities in the Maritimes, and only for part of each day. Helicopters generally have to fly from considerable distances, and are not always available.

Equipping for Day Trips


	Make people wear their personal flotation devices.
	Take CPR and First Aid courses.
	Find a good first aid book and carry it on the boat.
	Talk to your Family Physician about preparations if you have a medical problem.
	Take enough prescription medications, and don’t forget birth control pills.
	Bring everybody's provincial health insurance identity cards.
	Sunscreen, minimum protection factor of 20.
	Hats are critical in our hot summers.
	Fresh water for drinking.
	Insect repellant.
	Bandaids. Personally I prefer Elastoplast, because they stay on even when wet.
	Q-tips.
	First aid ointment like Polysporin or Bacitracin. It is a weak antibiotic, but very effective for protecting wounds while they heal. It works fine on burns too.
	Large sterile dressings and adhesive tape for large open wounds from injury or burn. These dressings keep wounds clean until we can treat them in hospital. You can apply gentle pressure to the dressing to control any bleeding.
	Scissors, like the kind nurses carry.
	Tweezers.
	Tensor bandages.
	Magnifying lens.
	Small flashlight.
	Safety pins.
	Acetaminophen (Tylenol) and an anti-inflammatory like Advil (ibuprofen).
	Benadryl for minor allergic reactions.
	Gravol for nausea.
	Wristbands to prevent seasickness. Once-daily Bonamine can also work.
	Decongestant nasal spray.
	Cough suppressant, like Benylin DM.
	Pepto-Bismol or Imodium for comfort from diarrhea.
	Over the counter steroid ointment for allergic skin rashes and insect bites. Hydrocortisone 0.5%.
	Antacid liquid or tablets.
	Adrenalin injector kit for people with known anaphylactic allergic reactions (rarely needed).
	Comfort eye drops (artificial tears).
	Aspirin. Two baby Aspirin can be very effective therapy for a patient having a heart attack caused by a blood clot, and you might be instructed to use it by a 911 dispatcher.
	Charcoal for poisonings. Use only on the advice of a professional.

Equipping for Coastal Cruises

Same as for day trips, plus:


	Extra amounts of prescription medications in case you are delayed.
	Copies of critical medical records, so that a physician who doesn’t know you can catch up accurately and quickly. Often a letter from your doctor is sufficient.
	Make sure your ditch bag is good quality and ship-shape.
	There is no need to take antibiotics. Physicians are same-day accessible in communities on all Atlantic Canadian Maritime coastal shores.

Equipping for Open Ocean (Offshore) Cruises

Offshore cruising is a different kettle of fish, and beyond the scope of this article. I have no experience with long offshore cruising. But I have read many stories of problems that people encounter when they are weeks at sea, and days from expert medical help.

The principles remain the same, but the list of gear is longer. It is important to carry sterile surgical instruments for simple procedures like draining abscesses. Wireless communication remains key. There are emergency physicians willing to provide long-distance advice by telephone for people caught with medical emergencies in remote areas, but organize that service before departing.

Ideas for Certified Health Care Providers

Physicians and other health care providers who are trained and certified to use them might also think about taking the following specialized equipment. These items should not be used by laypersons. In 18 years of professional life I have never had to do CPR or start an IV outside the hospital, but it can happen. Some of our coastal cruising takes place many hours from prehospital scene response. You can carry some of these items in a small special-purpose kit-bag from an ambulance supply store.


	Barrier mask for artificial ventilation.
	Blood pressure cuffs.
	Epinephrine ampule, 1:1,000.
	A variety of professional dressings, including 2” and 4” 4x4’s. Common antibiotics.
	Suture kit with local anesthetic.
	Scalpel and blades.
	Eye pad and shield.
	Stethoscope
	Tongue blades, otoscope, ophthalmoscope.
	Prednisone.
	D50W ampules.
	Ventolin inhaler.
	Tylenol #3.
	Sublingual Ativan (lorazopam).
	Reference material. Textbooks or handheld computer electronic books.

We use boats for recreation. Our boats cannot be turned into ambulances. So the following devices do not make sense on private boats, unless the provider is super keen, or officially supported in an EMS auxiliary program:


	We cannot be expected to carry endotracheal intubation gear routinely. It would probably never be used in a lifetime, and requires a specialized team environment with specialized drugs. Children are more likely to benefit from endotracheal intubation during respiratory arrest, but then the boater would have to carry and maintain a full array of ET sizes, along with multiple laryngoscope blades, multiple sizes of Magill forceps, a bagging unit and a suction device.
	It is not practical to carry oxygen on a small coastal cruiser, but should be considered for offshore trips, or when a passenger has a condition where oxygen might be required.
	Intravenous saline, catheters, and alcohol swabs can allow a provider to get an IV going before the patient is delivered to EMS, but they are rarely likely to make a difference before the ambulance arrives, especially if IV drugs are not available on board.
	Similarly semi-automatic defibrillators are controversial. They can save an adult life if ventricular fibrillation occurs, but this is a very rare event and the cost a device is very high.
	Intravenous drugs are controversial for coastal cruising, but do not make sense. They need to be maintained, and probably will never be needed in a lifetime.
	There are ECG devices for both Palm OS and Pocket PC handheld computers. An accurate diagnosis of the rhythm during symptoms is extremely important to the physician who later sees the patient in hospital, but it is unlikely that a boater will ever need one.

"Good Samaritan" laws support physicians and other trained providers to do the best the can when they are asked to help out in a situation when they are off-duty. When we are out and about in our private lives, nobody should expect us to be able to perform the way we can in our ambulance and hospital workplaces. We would be expected to perform to a level similar to others in our profession who would be caught in a similar situation. This means that some day we might be in the terrible position of watching someone suffer who we know could be helped in an Emergency Department, but we all need to accept that life carries that risk.

More Information:

Off-the-Shelf Medical Kits. Powerboat Reports. January 2002, pages 25-28.

Preparing for Medical Emergencies While Cruising, by Darrell Wyatt MD:
http://abacoguide.net/medical.htm

Doctor-on-Board
http://www.mjbovo.com/Writer/DocOnBoard.htm

Examples of commercial first aid/medical kits for boats:
http://www.safetystore.com/outsail.asp