Skip to main content

Fleet Surgeons Memo for Offshore Passages

emorandum 

assages 

Jeffrey S. Wisch, M.D.* 

PDF VERSION 

  

This memorandum is informational only and is not intended to be a substitute for  professional medical advice 

Medical skills, first aid equipment and the ability to communicate, impact the outcome of  an offshore medical emergency. In the Injury and Illness Survey of past Bermuda Races  the extremities, especially fingers and toes, were sites most at risk for injury. Sea  sickness and sunburn were common. Infections, migraine, diabetic dehydration, and  airway obstruction requiring a Heimlich maneuver were encountered. Offshore crew  training should stress the importance of avoiding hypothermia, dehydration, fatigue, and  seasickness.  

Conditions not encountered in these races must also be considered. The incidence of  malignant melanoma, as well as other skin disorders directly related to excess sun  exposure has increased alarmingly among sailors, according to records of the US Coast Guard. Asthma, life-threatening allergic reactions, heart attacks, strokes, seizures, and  surgical emergencies can be added to the long list of potentially treatable events one  might have to deal with on an offshore passage. Anticoagulants (blood thinners), which  are used to treat blood clots or cardiac conditions such as atrial fibrillation, can turn a  minor knock on the head into an untreatable and fatal hemorrhage in the brain. Finally,  while conditions, such as falling overboard and drowning or being hit on the head by the  boom or mainsheet during an accidental jibe have high mortality rates despite best rescue efforts, they are mostly preventable by always using an inflatable harness and tether  in the former case, and by a permanently installed and always engaged preventer, in the  latter. A culture of safety and prevention is the best way to minimize the risk of injury and  illness. 

 Acknowledging that not every medical situation can be handled safely and successfully  at sea, a single person, the Medical Officer, not necessarily a medical professional, has  the responsibility of caring for the ill or injured crew member offshore, preparing the  vessel and the crew for any likely medical emergency and being aware of the presence  or absence of medical and rescue resources. Significant medical conditions of individual  crew should be on record and known to the medical officer before departure One or more  crew members should have valid First Aid certificates. 

Medical training to improve the skills of a lay person who has become a yacht’s Medical  Officer is available in a number of commercial programs ranging from first aid to medical wilderness courses. Medical training is important because on a small boat there is no  “911” as we have come to know it and expect. CPR training is urged for all crew members. 

 

emorandum 

The Medical Officer must make sure that the following are available onboard the vessel: 

1. Information from each crew member about significant medical conditions,  allergies and necessary medications are easily accessible; 

2. Medical and surgical skills appropriate to the voyage; 

3. Appropriate medical supplies - reference books, a medical/surgical kit and  medicines (addenda 1-3), appropriate to the level of medical training on board; 4. An appropriate emergency communication system and training of the entire  crew as to the proper use of the equipment 

Another critical role is that of the Communications Officer who links the boat to outside  medical help and rescue services. VHF and Single Sideband radios and a suitable satellite  system for voice and/or email communication are usually found on an offshore yacht.  More than one crewmember must know how to use the equipment and whom to call. If  satellite communications are available, it is advised that emergency rescue phone numbers be readily available and programmed into the sat phone. During the Bermuda Races  2002 - 2024, competitors by pre-arrangement used the emergency department of a major  medical center to provide remote 24 hour medical advice to yachts. Similar services are  available commercially and should be considered by vessels planning offshore passages. 

RADIO PROCEDURE: 

a) Coast Guard Emergency/Distress Frequencies VHF - Channel 16;  Single Sideband – 4125, 6215, 8291,12290 kHz 

b) Radio broadcast protocol 

 1. Tune to correct frequency. 

 2. Say “pan-pan…pan-pan…pan-pan” (urgent) 

 Or “may-day…may-day…may-day” (life-threatening) 

 3. This is (yacht’s name) – three times. 

 4. Give call sign - twice. 

 5. Give latitude/longitude or other specific location. 

 6. State type of vessel. 

 7. State nature of emergency. 

When to Call USCG directly using standard emergency procedure 1. Unresponsive or minimally responsive patient-lethargic obtunded or confused 2. Obvious major trauma (amputation, severe head or facial injury, or severe  fracture) 

3. Respiratory distress – difficulty or unable to breath, rapid breathing, pale, ashen,  sweaty 

4. Cardiac distress – chest pain, pale, sweaty, difficulty breathing, elevated heart  rate HR >130, low blood pressure (<80 if able to measure) 

5. Severe or facial burns 

6. Obvious stroke symptoms – facial weakness, arm or leg weakness, speech difficulty, confusion 
 

 

emorandum 

Incident Presentation: information needed by a remote physician or rescue organization 

1. Level of Consciousness – orientation to person, place, time and event (alertness  and awareness) 

2. Chief complaint - primary problem 

3. History of present illness and mechanism of Injury – what happened and what   are the patient’s symptoms. 

4. Patient’s medical history – problems, medications, and allergies 

5. Physical findings – vital signs (heart rate, blood pressure, temperature,  respiratory rate, oxygen saturation), then problem focused exam 

6. Interventions – what have you done ; medications given 

Additional emergency Data: 

1. Distance from port or rescue (by sea or air) 

2. Medication and medical equipment on board 

3. Medical skill level of crew (MD, RN, EMT, APC) 

ADDENDUM 1: MEDICAL HANDBOOKS  

Basic: 

Advanced First Aid Afloat, by Peter F. Eastman, M.D., Fifth Edition: Cornell Mari time Press, Inc, Centreville, MD, 21617, 2002, ISBN 0 87033 524 3 

 First Aid at Sea, by Douglas Justins and Colin Berry, Adlard Coles Nautical, A&C  Black (Publishers) Ltd, 35 Bedford Row, London, WCIR 4JH, 8th Edition, 2022, ISBN 0  7136 4922 4 

 First Aid Afloat, by Fabian Steffen, Schiffer Publishing, Ltd., 2014 ISBN:  

9780870336362 

 Wilderness Rescue Medicine, by Jeff Isaac, PA-C and David Johnson, M.D. (8th  edition) https://www.wildmed.com/book-store/wilderness-and-rescue-medicine/, ISBN:  9798985002133 

Advanced: 

The Ship Captain’s Medical Guide, 23rd edition. Crown Copyright 2020. Obtainable  from His Majesty’s Stationery Office, Email: book.orders@tso.co.uk, fax: 44 (0)870 600  5533, tel: 44 (0)870 600 5522. 

 The Ship’s Medical Chest and Medical Aid at Sea, DHHS Publication (PHS) 84- 2024 Government Bookstore, O’Neil Building, 10 Causeway, Boston, MA 02222 (tele phone 617 565 6680) and www.fas.org/irp/doddir/milmed/ships.pdf. Comprehensive and  contains an extensive list of medical references. 

 

 

emorandum 

ADDENDUM 2: SAMPLE EQUIPMENT LIST: 

Seek medical advice from a physician and see handbooks for a more complete list of  equipment, as this is only a sample. The Medical Officer should be familiar with the indicated use of the contents in the medical kit. 

Medical kits must meet the objectives of intended voyage and the abilities of the ship‘s medical officer. Commercially available medical kits vary in complexity and if used their  contents should be reviewed to be sure they meet the objectives of the voyage. The items  below, or appropriate substitutes, are recommended. These recommendations however are  not intended to be a substitute for proper consultation with a medical provider. Neither  the publishers, nor the author will hold themselves responsible for errors, omissions, or  alterations in this list. 

Airway kit 

Oral airways (small medium and large) 

Ambu bag, CPR mask 

Bandages/Minor Trauma/Burns 

Adhesive tape: 1/2”, 1” and 2” )1.25, 2.5, and 5cm) 

Sterile dressings: Gauge sponges 4”x 4” (10cm x 10cm) 

Roll gauze 2” and 4” (5cm and 10cm)  

Band-aids 

Non-adhesive dressings: Telfa, Xeroform gauze (Vaseline impregnated gauze) 

Steri-strips: 1/4” and 1/2” (0.6cm and 1.2cm) 

Ace bandages: 2”, 4” and 6” (5, 10 and 15 cm) 

Sling and swath or Triangular bandages 

Large abdominal/trauma dressings: ABD Pad 

Finger splinting material; tongue depressors, aluminum splint 

Surgical Kit/Major Trauma 

Laceration tray: 1% or 2% Lidocaine, syringes with needles 18, 21 and 25 gauge Sterile Hemostat, needle driver, forceps, scissors, gauze sponges 

Sterile gloves: sizes 7, 7 1/2, 8 

Sterile drapes and iodine prep sticks 

Suture material: 5.0/ 4.0/ 3.0 nylon, 3.0 and 4.0 Vicryl or Dexon 

Dermabond 

Skin stapler 

Clozex (skin closures) 

Suture and Staple removal kits 

Scalpels: #11 and #15 blades 

Irrigation: 14-gauge angiocath 

ENT/Eyes/Dental 

Sterile Irrigation fluid for eye wash 

Nasal packing: Merocel nasal tampons 1 inch (2.5cm); Vaseline gauze 

Temporary dental filling kit

 

emorandum 

Splints 

Splints for arms, legs (prefabricated or inflatable) 

Finger splinting material: tongue depressors, aluminium splints 1/4” and 1/2”  

 (0.6cm and 1.2cm) 

Cervical spine collar 

Urinary 

Bladder catheterization kit ( sterile) 

Examination tools - ancillary equipment 

Blood pressure cuff, Stethoscope, Thermometer, Fingertip pulse oximeter, N95   masks, Covid 19 rapid tests kits 

Intravenous fluid administration kit, Hypodermoclysis kit 

ADDENDUM 3: SAMPLE MEDICATION LIST: 

See handbooks for more complete lists. Medications should be assembled and given with  the advice of a physician. Medicines available “over the counter” are in regular type.  Prescription medications are in italics. Know about allergies or adverse reactions before  giving any medication. Instructions must be strictly followed. 

ILLNESS or PROBLEM MEDICATIONS 

Allergic reactions Benadryl, Epinephrine, EpiPen, Prednisone 

Antihistamines Benadryl; Claritin, Allegra, Zyrtec 

Antiseptic solutions Betadine, Hibiclens, Alcohol 

Asthma Albuterol inhaler 

Burns Bacitracin Ointment, Silvadene cream; Vaseline 

Cardiovascular Epinephrine, Sublingual Nitroglycerine, Aspirin,  

Constipation Milk of Magnesia, Senna, Colace, Dulcolax suppository,   Fleet enema, 

Cough Robitussin, Tessalon Perles, Mucinex 

Diarrhea Imodium, Kaopectate, D50 IV, oral sugar solution 

ENT/Dental Cortisporin Otic Suspension , Ciprofloxacin Otic, Cepacol   lozenges  

Nasal congestion Sudafed, Afrin nasal spray, decongestants 

Eyes Erythromycin ophthalmic ointment, Gentamicin ophthalmic,  Artificial Tears 

Gastritis Maalox, Prilosec (omeprazole), Flomax (male) 

 

 

emorandum 

Infection/ Antibiotics 

Urinary Tract Ciprofloxacin, Bactrim DS, Levofloxacin 

Respiratory Azithromycin, Levofloxacin, Augmentin 

ENT/Dental Amoxicillin, Augmentin, Clindamycin 

Gastrointestinal Metronidazole, Ciprofloxicin, IV Ceftriaxone, 

Skin/soft tissue Cephalexin, Augmentin, Dicloxicillin 

Vaginal Miconazole (Monistat) 

ILLNESS or PROBLEM - MEDICATIONS:  

Covid 19 Infection** Paxlovid (antiviral) 

Intravenous Fluids Normal Saline (0.9% saline) 

 D5 1/2 NS (5% dextrose & 0.9% saline) 

Inflammation/Pain Tylenol, Ibuprofen 

Local Anesthetic*** Lidocaine 1% or 2% with and without epinephrine   (injectable) Marcaine 1.25% 

Pain Medication Oxycodone, injectable Morphine 

 Acetaminophen, Ibuprofen, Aspirin 

Seasickness**** Scopolamine transdermal patches, Dramamine,  

 Stugeron (Cinnarizine OTC in UK, Ireland, Spain & Bermuda)  Compazine or 

 Phenergan (Promethazine) rectal suppositorie

Sleep/Anxiety Benadryl, Lorazepam (Ativan), Ambien 

Sunburn: Topical aloe, Solarcaine 

*Special thanks to William Strassberg, M.D., Chair of CCA Safety and Seamanship  Committee for his contribution to this Memo. 

** Covid 19 is a changing situation. Please refer to CDC guidelines for up-to-date recommendation 

***Lidocaine with epinephrine should never be used for local anesthesia in fingers and  toes due to the possibility of digital vascular constriction and necrosis. 

**** Due to potential side effects of seasickness medications, these medications should  be trialed on shore prior to use on board.