Reeds First Aid Handbook (Martin Thomas Olivia Davies) (Z-Library)

REEDS
FIRST AID
HANDBOOK
REEDS
Bloomsbury Publishing Plc
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Copyright © Martin Thomas and Olivia Davies, 2024
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REEDS
FIRST AID
HANDBOOK
Martin Thomas
& Olivia Davies

CONTENTS
Introduction vii Burns 41
Hypothermia and drowning 46
Planning 1 Eyes 49
Cold and fatigue 3 Ears 52
Nose 53
Seasickness 4 Teeth 55
Prevention 5 Skin 56
Medication 6 Frostbite 59
Seasick crew 7
Acute medical illness 60
Drugs 8 Infections 60
Painkillers 9 Anaphylaxis 63
Other drugs 11 Diabetes 64
Chest disorders 66
Resuscitation 12 Epilepsy 69
Airway 13
Stroke 71
Breathing 14
Abdominal disorders 73
Circulation 15
Urinary disorders 77
Chest compressions 16
Gynaecological disorders 79
Rescue breathing 17
Bites and stings 81
Cardiopulmonary Resuscitation
Heat 85
(CPR) 19
Dehydration 86
Recovery position 21
Tropical diseases 87
Choking 22
Poisoning 89
Unconscious crew 24
Medical evacuation 90
Trauma and injuries 26 Reasons for early or urgent
Minor wounds: cuts and
medical evacuation 93
lacerations 26
Hands and feet 27 Medical kit 94
Bleeding 29
Fractures 32 Drugs 96
Specific fractures 34
Index 98
Head injuries 39
vv
Introduction
INTRODUCTION
This book is written for anyone who sets sail on a vessel
without a medic aboard – so most vessels at sea.
Although there is a limit on what can be done on a

small boat, nevertheless with appropriate intervention
as described in this handbook, the medical condition
of a patient can be significantly improved and in some
circumstances lives can even be saved.
Skippers and their crew, especially long distance sailors,
are advised to attend a training course in first aid. Advice
on more expert interventions (from giving someone fluids
intravenously to inserting a chest drain) are not offered
in this handbook. These manoeuvres are potentially
hazardous if attempted by non-medics unfamiliar and
untrained in such techniques.
For bigger boats with a larger crew and for those
travelling long distances to remote areas, it is advisable to
have aboard a crew member designated as responsible
for medical care. This person might be a medic, a nurse
or someone who has specifically trained in first aid and
marine or wilderness medicine.
Martin Thomas
Olivia Davies
viivii
Planning
PLANNING
Before setting sail thought must be given to the medical
care of the crew. The longer and more remote the voyage
the more essential is detailed medical planning. The
skipper must be aware of any health problems amongst
those on board. If a crew member has a medical condition
such as diabetes, epilepsy, hypertension, heart problems,
allergies, asthma or other breathing problems then not
only must they tell the skipper but they must also take
adequate medication for the entire trip. If a crew member
knows that they are likely to be seasick, they should
take enough of their own preferred medication and not
deplete the ship’s stocks.
If the voyage is planned for parts of the world where
immunisation is required, then seek medical advice
beforehand. Leave plenty of time to get immunised –
at least three months. Remember to arrange malarial
prophylaxis and to start taking it in advance. A dental
check-up is also sensible to avoid the misery of a dental
abscess mid-ocean.
Any long distance sailor and certainly the skipper
should attend a recognised course in first aid and basic
medical procedures. A boat crossing any stretch of open
sea should have two people aboard who can perform
cardiopulmonary resuscitation (CPR). The boat must be
furnished with a simple first aid manual and a larger more
comprehensive medical manual.
Thought must be given as to which drugs and medical
kit will be taken. The drugs and kit must be appropriate to
the voyage planned and the crew aboard. Drugs are like
nautical knots – the boat needs a few good ones that work
well and are familiar to the crew.
Take details of a shore-based medical facility prepared
to give long distance medical advice via telemedicine.
11
Planning
Examples are MSOS (Medical Support Offshore) run by

PLANNING
Dr Spike Briggs, PRAXES (Clipper Telemed) and Medaire.

International MRCCs (Maritime Rescue Coordinate Centres)
such as the one at Falmouth, UK, will also arrange medical
advice. A satellite phone is the most convenient way of
receiving such information or else use the Inmarsat-C
messaging system. It is wise to take out medical insurance
to include repatriation.
Prevention is better than cure

A crew that is well fed and adequately rested will suffer
fewer medical problems. This means regular proper meals
and a well run watch system. Crew on a tidy vessel run
‘shipshape and Bristol fashion’, with a place for everything
and everything in its place, will suffer fewer injuries.
Particular care must be taken when attending the
anchor, the windlass or the engine. Crew should know
and practice methods for reefing in heavy weather, for
gybing, mast climbing and inspecting the propeller. Such
familiarity will reduce the risk of a significant injury.
Crew should wear a lifejacket, a harness and clip on at
night, in rough weather and when in the cockpit alone. It
is wise to inform another crew member whenever going
forward of the mast for any reason, especially at night.
When cooking it is wise for crew to wear trousers, maybe
an apron, and shoes. Crew below must beware, it is so easy
to be thrown across the cabin. Remember: one hand for
the boat and one for yourself.
2 2
In a reasonably small boat at sea, cold and fatigue can
COLD AND FATIGUE

render crew members unable to function. The impact
of this must not be underestimated. Fatigue can lead to
poor decisions and errors that place the vessel in danger.
Crew must wear clothing appropriate to the conditions.
Good weatherproof outer garments are essential to keep
out wind and water. Layering of clothing is the key to
warmth. Wrap up in good time, even before the boat sets
sail and certainly before the risk of getting wet. If a sailor is
drenched then a change into dry clothes is essential. Wind
chill on wet clothes can lead towards hypothermia.
Fatigue can creep up unnoticed, which is why certain
occupations (lorry driver, airline pilot) have limited work
hours. The key to avoiding fatigue is a good watch system
for both the crew and the skipper. Anxious, inexperienced
skippers can stay on deck too long and become tired and
unreliable. Regular meals taken off watch, preferably hot,
are good for morale and contribute to the effectiveness
of the ship’s company. Crew must take regular rest, food
and drink (preferably not alcohol), so that when the crisis
occurs they can deal with it judiciously.
33
Seasickness
SEASICKNESS
Every seafarer has been afflicted by seasickness at some

time, but a crew member suffering from it can become
unable to function thus reducing the number of effective
crew to work the boat.
Motion sickness occurs when there is a disconnect
between the body’s perception of motion and the actual
motion – the sensory conflict theory. Sickness can be
caused by motion that is felt but not seen. This applies
when down below where the eyes perceive no movement
but the vestibular apparatus in the middle ear does. Early
symptoms include lethargy, yawning, excess salivation
and sweating. Then come fatigue, headache, dizziness and
eventually nausea and vomiting.
4 4
Prevention
SEASICKNESS
Seasickness is another malady where prevention is
important as there is no specific cure.
 Set out on the voyage rested, well hydrated and alcohol

free.
 Avoid alcohol for 12 hours prior to sailing.
 By setting out in calmer weather and perhaps going
to a quiet anchorage for the first night, a process of
acclimatisation can begin. Finding one’s ‘sea legs’ takes
most people no more than 48 hours.
 Ginger has been shown to be helpful in warding off the
malady. Ginger taken as capsules or sachets or as ginger
biscuits may help. Other remedies recommended, such
as cola drinks or warm tea, probably act solely through
the placebo effect.
55
Medication
SEASICKNESS
Medication designed to prevent seasickness should be

taken the evening before departure or earlier. Not to
take medication until symptoms appear is a grave error.
Attempting to treat sickness once it has occurred is the
least effective option and rarely works. So much better to
take the tablets early when they will stay down and work.
Drugs for motion sickness are listed in the Medical
Equipment section (see page 97). All such medications
cause drowsiness. Hyoscine is an anticholinergic drug
that can be taken as a tablet or applied as a dermal patch
behind the ear. Wash the hands after applying the patch
so that hyoscine is not absorbed from them. A number
of antihistamine preparations such as cyclizine and
meclizine are helpful. Cinnarizine is popular in Europe and
other countries outside the USA because of the balance
between efficacious treatment and side effects.
Beware overdosing on anti-sickness medication. This
can lead to tachycardia (fast pulse), dilated pupils (causing
blurred vision), tremor, agitation and confusion.
6 6
Seasick crew
SEASICKNESS
Some crew on passage will become sick. A good skipper
will spot the early signs and advise prompt action.
Anecdotal evidence suggests that the skipper and
helmsman are less susceptible to sickness than other
crew with no specific task. At the first sign of seasickness,
one tactic is to give the sufferer the helm. This requires
concentration but also allows the eyes to focus on the
horizon.
Sick crew can sit in the cockpit wearing a harness and
tether looking at the horizon. Once beyond any task they
should move below and be placed in a comfortable warm
bunk secured by a lee cloth with adequate supporting
cushions (and a bucket). A completely empty stomach
can render sickness worse. Loss of fluid from vomiting
and the inability to take fluids will lead to dehydration and
lethargy.
Isotonic drinks are preferable to water as they replace
lost sodium. Oral medication is less helpful at this stage
as tablets may not stay down. Hyoscine is a faster acting
anti-emetic than most and can be taken by chewing or
sublingually (under the tongue). In extreme cases an
injection may be required.
These measures are usually enough to allow
improvement. Some poor souls, however careful and
disciplined, suffer the misery of profound unremitting
illness. They can slump into a desperate catatonic state
of hypothermia, fatigue, dehydration and vomiting semi-
coma. The only cure is to reach dry land. As Spike Milligan
said, ‘The only sure cure for seasickness is to sit under a
tree.’
77
A skipper must consider carefully which drugs to take on
DRUGS
the voyage and remember that all drugs have side effects.
Crew should be responsible for bringing a supply of their
own prescription medications. Drugs for motion sickness
are dealt with in the section Seasickness (see page 7).
Antibiotics are discussed in the section Infections (see
page 60). Drugs for analgesia (pain relief ) are essential on
a boat but must be chosen carefully.
8 8
Painkillers
DRUGS
Paracetamol (acetaminophen in the USA) will provide
adequate relief for low level pain. Non-steroidal anti-
inflammatories (NSAIDS) such as ibuprofen, diclofenac
or naproxen can be taken with paracetamol and the
effect is synergistic; the pain relief achieved is stronger than
either drug alone. NSAIDS should be used with caution in
those with asthma or gastritis. In some cases to administer
an NSAID drug can cause fatality in an asthmatic patient.
These drugs also cause bleeding from the stomach and
so should be avoided in those with gastritis or stomach
ulcer. Aspirin is an alternative analgesic to NSAIDS but
both should be avoided in people on blood thinners.
Combining these non-opioid analgesics will cover most
moderate pain.
Codeine is a mild opioid and a stronger analgesic, which

again is more effective in combination with non-opioid
analgesics, for example it is available together with
paracetamol as Co-codamol. A minority of people derive
no benefit from codeine, lacking the ability to metabolise
it. Codeine causes constipation so prolonged use is not
advisable.
Tramadol is an effective prescription-only opioid and

less addictive than morphine. The skipper must decide
whether to carry aboard morphine (a strong opioid and
prescription only). For serious trauma it can be invaluable
but storing morphine aboard can present problems. If it
is planned to take opioids on the boat, be sure to discuss
with the prescribing doctor and arrange a secure place on
the boat.
99
Painkillers
Mild pain Non-opioid analgesics

DRUGS
Paracetamol 1g, 4 times a day

If needed add NSAID (ibuprofen
400mg, 3 times a day; diclofenac
50mg, 3 times a day or 100mg
suppository 1 time a day; or
naproxen 500mg, 2 times a day)
Or: aspirin 300mg, 4 times a day
(maximum 4g a day)
Moderate Mild opioid analgesics

pain Codeine phosphate 30mg, 4
times a day (can be combined with
paracetamol as co-codamol)
Or: tramadol 50mg, 4 times a day
Plus: non-opioid analgesics
Severe pain Strong opioid analgesics (stop weaker

opioids but beware of respiratory
depression)
Morphine 10mg or 20mg, 1 an hour;
or oxycodone 5–10mg, 2 an hour
Plus: non-opioid analgesics
If the patient cannot keep down the medication, perhaps

through seasickness, then a different route of administration
is required. Prescription-only opioids such as fentanyl can
be taken sublingually (under the tongue) and tramadol
can be administered as oral drops. Suppository is another
mode for giving a drug. A suppository of diclofenac is a
powerful painkiller. Injection is the most effective way of
administering analgesia but requires needles and syringes
and a degree of expertise. Such injections are best given
intramuscularly into the front or outer aspect of the thigh.
Intravenous injections should only be given by
those with the relevant skills.
10 10
Other drugs
DRUGS
Drugs for acute medical emergencies such as anaphylaxis
also present a problem. Adrenaline, present in the
EpiPen, is dangerous if not used properly. Accidental
administration can lead to cardiac problems and if injected
in an inappropriate place, such as into the hand, can cause
arterial spasm and even the loss of a finger. It is preferable
to inject EpiPen only once and into the thigh.
Corticosteroids such as prednisolone can be helpful
in the management of respiratory disease and allergy. A
bottle of oxygen, say 400 litres, takes up storage space but
may be live-saving for respiratory distress or collapse.
Other medications (such as antihistamines, hydro
cortisone cream, antacids, laxatives and rehydration
tablets) are covered in the appropriate chapters and listed
in Medical Equipment under Drugs (see page 96).
1111
Basic life support and cardiopulmonary resuscitation (CPR)
RESUSCITATION
should be started on any person who is unresponsive

with abnormal or absent breathing (see the Basic Life
Support table, page 19). It is not always easy to ascertain if
someone is dead (has suffered a cardiac arrest), particularly
if they have profound hypothermia. Assess if they are
responsive by gently shaking and speaking loudly. If in
doubt, resuscitation must be instituted.
Move the patient to a place in the boat where resuscitation

can most easily be performed. The cabin sole is the best
place. It provides a firm base low in the vessel protected
from the weather. As the patient is being moved to a
suitable place, shout for help (if within range ask a crew
member to call the Coast Guard or else an MRCC such as
at Falmouth). Start with a rapid assessment using A, B, C –
Airway, Breathing, Circulation.
12 12
Airway
RESUSCITATION
1 With the patient on their back, open the airway by
tilting the head back.
2 Place one hand on the forehead, applying pressure to

tilt the head back.
3 Place fingers of the other hand under the chin and

gently lift upward. Placing fingers under the angle of the
jaw and lifting forwards (a jaw thrust) is also effective but
takes two hands.
1313
Airway
If there is a suspicion of traumatic cervical spine injury,

RESUSCITATION
keep the head and neck as still as possible using manual

in-line stabilisation: kneel behind the patient’s head
and place one hand either side of the head to minimise
movement. If you are solo this will not be possible and you
will have to prioritise resuscitation.
4 Remove any foreign bodies that might obstruct

breathing such as tongue, dentures, food, vomit and
blood.
Breathing
Take up to 10 seconds to check for breathing. Look for chest

movement, listen at the patient’s mouth for breathing, and
feel for breath on your cheek. These three actions (looking,
listening and feeling) can all be done simultaneously.
If the patient is breathing then place in the recovery

position. If breathing is abnormal or absent start chest
compressions.
14 14
Circulation
RESUSCITATION
If there is any doubt over signs of life or a pulse, start CPR
– do not delay. Time can be wasted seeking a pulse in a
shocked or hypothermic patient. If you are trained, feel for
a carotid pulse. (To become proficient at finding a pulse,
practice gently on yourself or a friend at home but only try
on one side of the neck at a time.)
1515
Chest compressions
RESUSCITATION
1 To perform chest compressions effectively, lay the

patient on a hard surface such as the cabin sole.
2 Place the heel of one hand over the centre of the lower
half of the sternum (breastbone), put the other hand on
top and interlace the fingers.
3 With the arms locked straight compress the chest by

5cm, or one third of the chest depth, at a rate of 100–120
compressions a minute – nearly twice every second.
Allow the chest to re-expand between each
compression. Keep your hands in contact with the
sternum, do not ‘bounce’ on the chest. For a child use only
one hand.
16 16
Rescue breathing
RESUSCITATION
A rescue breath supplies oxygen to the lungs. If you are
trained to perform rescue breaths, deliver 2 rescue breaths
after 30 chest compressions.
1 Kneel next to the patient’s head.
2 Be sure to maintain the open airway by tilting the head

backwards.
3 Pinch the nostrils closed, take a breath, seal your lips

around the mouth and blow.
4 Observe chest expansion then break the seal by

removing your mouth and watch the chest exhale.
1717
Rescue breathing
If you are unable or unwilling to give rescue

RESUSCITATION
breaths, give continuous chest compressions. Properly

administered chest compressions, without rescue breaths,
can provide effective resuscitation.
AT A GLANCE – Basic Life Support

Unresponsive and not breathing normally?
 Call for help

 Attach AED if available
 30 chest compressions
 2 rescue breaths
 Continue CPR using 30:2 ratio
18 18
Cardiopulmonary Resuscitation (CPR)
RESUSCITATION
Call for help from the rest of the crew and begin CPR
without delay. CPR is a combination of chest compressions
and rescue breaths. Perform rescue breaths at a rate of
2 breaths every 30 compressions.
CPR can be exhausting and is best done by two or more

people. The roles can be reversed and shared. Chest
compressions alone are effective and can be continued
without rescue breaths.
Minimise any interruptions to CPR and do not waste time

by pausing to search for a pulse. CPR should be continued
until breathing starts or the patient is considered beyond
saving; persist for at least 30 minutes and in some cases
1919
Cardiopulmonary Resuscitation (CPR)
longer. CPR should be prolonged in cases of hypothermia,

RESUSCITATION
drowning, electrocution and in children, when you should

continue for an hour if you are able.
If an Automated External Defibrillator (AED) is
carried aboard it should be attached, turned on and the
instructions followed as soon as possible after cardiac
arrest is identified. In certain abnormal cardiac rhythms,
ventricular fibrillation or pulseless ventricular tachycardia,
a shock is necessary. For this reason some vessels carry an
AED, which reads the heart rhythm and can be used by an
untrained person. An AED is little use in remote areas – it
is only worthwhile carrying one if evacuation to a medical
facility can be arranged expeditiously.
Early evacuation. Patients who recover following CPR

require early evacuation.
20 20
Recovery position
RESUSCITATION
A person with decreased consciousness who does not
require CPR should be placed on their side in the recovery
position.
1 Kneel beside the patient.
2 Bend the arm closest to you at a right angle with palm

up.
3 Bring the far arm across the chest and rest the back of
the hand on the cheek.
4 Grasp the far leg behind the knee and bend the knee
to a right angle.
5 Keeping the hand against the cheek, pull on the far leg
to roll the person towards you until they rest on their side.
6 Tilt the head back to maintain an open airway. Check

regularly for normal breathing.
2121
Choking
RESUSCITATION
What to do about choking
Choking
Assess severity
SEVERE MILD
Airway obstruction Airway obstruction
(ineffective cough) (effective cough)
Unconscious Conscious Encourage cough
Start CPR 5 back blows Continue

to check for
deterioration
5 abdominal until obstruction
thrusts relieved
A foreign body can obstruct the airway and cause choking.

The most common in fit people is a food, usually meat.
Blood and vomit can also be to blame. If the obstruction
is mild encourage the patient to cough. If the obstruction
is severe (they are unable to speak or cough) give 5 back
blows.
22 22
Choking
RESUSCITATION
1 Lean the patient forwards over an arm supporting the
chest and give five firm and sharp blows on the back
between the shoulder blades.
2 If these back blows fail to relieve the obstruction then

attempt abdominal thrusts.
3 Stand behind the patient and put both arms around

the upper part of the abdomen.
4 Place one clenched fist in the upper abdomen below

the sternum (breastbone), grab the fist with the other
hand and pull sharply inwards and upwards. Repeat this
up to 5 times.
It is wise to warn the patient before attempting these
manoeuvres. If the patient becomes unconscious, start
CPR, which may help in dislodging any foreign body.
2323
Unconscious crew
RESUSCITATION
A crew member may collapse and become unconscious

for various reasons. An unconscious person who is still
breathing and has a pulse should be placed in the recovery
position while the cause is established.
Causes of decreased consciousness

Trauma Head injury
Severe blood loss
Drowning
Electrocution
Syncope Fainting due to:

 Low blood pressure
 Low blood sugar
 Dehydration
Allergy Anaphylaxis due to food or an insect

sting
Illness Diabetes (low or high blood sugar)

Heart attack
Arrhythmia
Stroke
Epilepsy (seizure)
Sepsis (severe infection)
Poisoning Carbon monoxide

Smoke inhalation
Alcohol
Drug overdose
24 24
Unconscious crew
If the patient remains unconscious over a period of time
RESUSCITATION
beware of the pressure areas. Hips, knees, elbows and
eyes are at particular risk. Use cushioning over pressure
areas and be prepared to roll the patient every 2 hours or
so. Secure them safely in a bunk with a lee cloth. If loss
of consciousness has lasted more than 2 hours consider
catheterising the bladder (a boat sailing any distance
offshore should carry a catheter).
A, B, C
Airway Check airway is open and unobstructed
Breathing Check the patient is breathing
Circulation Check the heart is pumping by feeling

the carotid pulse
Early evacuation. An unconscious patient requires

early evacuation.
2525
Minor wounds: cuts and lacerations
TRAUMA AND INJURIES
Cuts are caused by sharp edges while a laceration is more

of a tear to the skin. They should be inspected for foreign
material such as wood splinters or grease and then washed
with antiseptic. A clean cut can be closed by suture, staple,
tape or glue and covered with a sterile dressing.
Although wound tapes are the easiest to apply, they are

not suitable if the skin is wet or over a joint that may be
flexed. If using glue, care must be taken to prevent spillage
onto other parts of the patient or onto the carer (don’t
glue yourself to the patient). Glue should only be used on
straight, dry, non-bleeding wounds and not used for cuts
over joints.
Suturing and stapling require a level of expertise that is
easily attained on a first aid course. Staples when properly
applied have the advantage of speed but do not use them
on the face. Suturing will stop skin edge bleeding, which
in the case of the scalp can be profuse.
A dirty, contaminated cut or ragged laceration should
be cleansed, foreign material removed, thoroughly
rinsed in antiseptic solution and left unsutured and open
before a sterile dressing is applied. If antiseptic solution
is unavailable or has run out, then use boiled (and then
cooled) salt water.
26 26
Hands and feet
TRAUMA AND INJURIES

Hands can be injured by fishhooks, knives, scalding, rope
burns and more. Even minor hand injuries must be taken
seriously. It is difficult to help run a boat with only one
functioning hand.
On deck, bare feet are susceptible to injury and below
deck from scalding in the galley. Very severe injuries to
hands or feet, even with the loss of a digit, can be inflicted
by the anchor windlass, electric winches, engine, prop
shaft, propeller and in the galley.
Fishhook injuries
Remove a fishhook by pushing it on through, by removing
the barb or by the string technique.
The injured hand must be washed with antiseptic and

dressed with a non-stick dressing. Keep the fingers apart
by dressing them separately. The fingernail may be partially
avulsed. This is a painful injury that can bleed. Do not try to
2727
Hands and feet
remove the nail. Instead replace it into position and cover

TRAUMA AND INJURIES
with a soft dressing held in place with a bandage.
Fingernail injuries
A painful haematoma or bruise may occur under the
nail following crushing or a heavy blow to the finger.
The nail will appear black and be extremely painful. The
haematoma should be released. This is best achieved by
burning a hole through the nail with a hot pin or paperclip
heated in a flame and held with pliers. Continue applying
the pin until loss of resistance is felt and the blood escapes.
This procedure is surprisingly pain free.
Crush injuries
Crushing injury of the hand or foot can damage deep
tissues such as muscles and tendons and bone as well
as the skin. A crush injury causes extremely painful and
intense swelling even though bleeding may be slight.
Elevate and cool the limb to reduce swelling. Once the
swelling eases, the pain will recede but meanwhile give
adequate pain relief.
Early evacuation. A severe hand injury with loss of

function requires early evacuation.
28 28
Bleeding
TRAUMA AND INJURIES

Bleeding is best staunched by direct pressure over the
bleeding point with a sterile dressing for at least 10
minutes.
 Bandage the bleeding point firmly.

 If a limb is bleeding, lay the patient down, apply the
bandage and elevate the part.
 If blood appears through the bandage, then apply
another dressing and a second firm bandage over the
first. Do not remove the initial dressing as this may
disturb blood clotting.
 Be sure not to bandage so tightly that the circulation to
the extremity is compromised.
 Analgesia (pain relief ) may be required as pain can
make shock worse.
 Fluids to replace the loss of blood should be
administered.
 Care must be exercised when pressing directly near the
trachea (windpipe) or the eye.
2929
Bleeding
Tourniquets
TRAUMA AND INJURIES
Unless you are experienced do not apply a makeshift

tourniquet. Injudicious application of a tourniquet, by
obstructing the veins but failing properly to occlude the
arteries, can exacerbate haemorrhage from a limb. A tight
tourniquet will cut off the circulation to the limb. Only
attempt to apply a tourniquet if haemorrhage from the
limb is life-threatening.
If a tourniquet is to be applied, it should be at least 5
cm wide and flat so that it does not cut through the skin.
A wide sail tie placed over a bandage to protect the skin
will do.
1 Pass the tourniquet around the limb and tie a knot.

2 Put a stick or metal rod on the knot and tie another knot
over the rod. Then twist the rod as a Spanish windlass to
tighten the tourniquet.
3 Tie the other end of the rod to prevent it unwinding.
30 30
Bleeding
TRAUMA AND INJURIES

4 Note the time when the tourniquet was applied. After
an hour gently loosen the tourniquet to allow blood to
the extremity. Bleeding may have eased sufficiently for
it to be controlled by direct pressure. If not then twist
the Spanish windlass again.
AT A GLANCE – Bleeding
 Staunch the bleeding by direct pressure
 Apply sterile dressing and firm bandage
 Elevate the bleeding body part
Early evacuation. A patient suffering major haemor

rhage that cannot be adequately staunched requires
early evacuation.
3131
Fractures
TRAUMA AND INJURIES
A fracture at sea is always serious and if it involves a long

bone extremely serious. Any kind of fracture can be painful
and difficult to treat and leaves the rest of the boat’s crew
short-handed. Fractures of large bones such as the pelvis
or femur may be associated with significant blood loss.
Intense swelling or the acutely angled leg bones can
obstruct the circulation in the limb.
In principle fractures should be gently reduced (by
pulling, straightening and putting the bone back in line)
and then immobilised with a splint.
Immobilisation is crucial as it is movement of the fracture

that causes severe pain. Analgesia and fluids, the treatment
of shock, are important in the management of a fracture.
The patient with a broken bone, especially a break of the
leg, needs to be immobilised in a bunk with a lee cloth to
prevent further injury.
32 32
Fractures
Compound fractures
TRAUMA AND INJURIES

A compound fracture is one where the skin is broken. The
bone may or may not be protruding from the wound. Such
a fracture makes things more complicated because of the
risk of infection and for that reason should be cleaned with
antiseptic solution.
AT A GLANCE – Fractures
 Reduce the fracture and re-align the bones
 Immobilise the fracture with a splint or sling
 Immobilise the patient in a bunk to avoid further
injury
 Give pain relief
 Give fluids
 Give antibiotics if fracture is compound
3333
Specific fractures
TRAUMA AND INJURIES
Finger or toe fracture/dislocation

The fracture/dislocation should be reduced as quickly as
possible by pulling the digit before sensation returns. The
injured digit, usually a finger, should then be strapped to
an adjoining finger or a finger splint.
A dislocation should be immobilised in this way for a week

or so, a fracture for several weeks.
Forearm and wrist (radius and ulna)

Reduce the fracture by gently pulling and straightening
then, if possible, apply a splint from above the elbow, bent
to a right angle, to the hand. Curl the hand and fingers
around something soft like a length of rolled-up bandage.
34 34
Specific fractures
Upper arm (humerus)
TRAUMA AND INJURIES

Use a bandage to make a collar and cuff. Support the arm
by tying the bandage around the wrist and up around the
neck.
The weight of the arm will help to reduce the fracture. A

second broad bandage can hold the arm to the side.
Clavicle
Support the arm in a sling.
3535
Specific fractures
Upper leg (femur)

TRAUMA AND INJURIES
The other leg can be used as a splint. Place soft padding

between the legs – a pillow works well. In addition and for
extra effective splinting, a storm board or oar with plenty
of padding can be strapped down the outside of the leg.
The splint should immobilise the joint above and below

the fracture. This means that the outer splint must reach at
least as high as the abdomen or chest.
Lower leg (tibia)

Place a pillow between the legs and a padded outer splint
up to thigh, level high enough to immobilise the knee.
36 36
Specific fractures
Ankle
TRAUMA AND INJURIES

Distinguishing between a fracture, dislocation or sprain
can be difficult. For any of these, immobilise the foot in
the neutral position with the ankle at a right angle. A
U-shaped splint may help. Elevate the foot.
Jaw
A fracture of the jaw causes pain in the face and jaw, mainly
located in front of the ear on the affected side, and worse
on movement. The face will be swollen and bruised and
blood may ooze from the mouth. The patient will have
difficulty opening or closing their mouth. Remove broken
teeth and blood. Lean the patient forwards to allow blood
and fluids to drain. Maintain their airway at all costs. Apply
a Barton head bandage.
Commence antiseptic mouth washes and start antibiotics.

Allow only fluids by mouth.
3737
Specific fractures
Ribs
TRAUMA AND INJURIES
Sit the patient upright. They may need to be comfortably

wedged in position against the roll of the boat. Multiple
rib fractures may cause difficulty with breathing and
reduce the amount of oxygen reaching the lungs. Give
plenty of analgesia but do not give opiates, which can
depress breathing. Specific measures such a strapping
are not usually helpful. Should there be an open sucking
wound immediately cover it, initially with a hand, then
apply a sterile or clean dressing to seal the wound and
render it airtight.
Early evacuation. A patient with a fracture of pelvis,

upper leg, jaw or multiple ribs requires early evacuation.
38 38
Head injuries
TRAUMA AND INJURIES

Minor head injuries at sea are common. Children now
wear helmets when sailing dinghies. More adults also
wear helmets sailing yachts, especially at the start of a race
when manoeuvring briskly.
A severe head injury from the boom can be fatal. In a
gybe, for instance, as the boom swings across, either the
boom or the mainsheet can cause severe, even lethal,
damage. More than ever in this situation prevention is
better than cure – avoid a head injury at all costs. Employ a
boom preventer or a boom brake. When sailing downwind
in heavy weather consider dropping the main, fixing the
boom and running on headsails alone. When going over the
side to inspect the hull or propeller or when climbing the
mast, wear a helmet. A simple climber’s helmet will suffice.
Concussion is a short period of unconsciousness
or confusion followed by rapid recovery. There may
be amnesia of the event. Pain in the injured area may
be eased and the swelling reduced by holding a cold
compress, such as a bag of ice cubes, to it intermittently
for short periods. Associated headaches can be treated
with analgesia such as paracetamol.
The patient should be carefully monitored for
deteriora tion. Later symptoms may include continued
headache, drowsiness, nausea, vomiting, double vision,
confusion, fitting and further loss of consciousness. Such
deterioration is extremely serious and early evacuation
must be considered.
In the case of severe head injury when the patient
is unconscious with no recovery, open the airway,
immobilise the cervical spine perhaps with a collar and
place in a bunk with supporting pillows. Check for other
injuries. Bleeding, for instance from a scalp wound, should
be staunched by direct pressure and later suture.
3939
Head injuries
The unconscious patient must be monitored and

TRAUMA AND INJURIES
have the pulse rate, breathing rate, pupil size and

response recorded every half hour. For response, record
the conscious level (AVPU – see the table below) and
the times. This will provide a sufficient record at sea. The
Glasgow Coma Scale (GCS) is another, more detailed,
method of recording level of consciousness using eye,
motor and verbal responses. The important point in the
case of an unconscious patient is to record carefully the
responses and the times.
Monitor consciousness level: A, V, P, U

A Alert Alert
Response to vocal stimuli, by
V Vocal speech or eye opening
Response to painful stimuli

P Pain by speech, eye opening or
movement
U Unresponsive Unresponsive to any stimulus
AT A GLANCE – Head injuries

 Open the airway
 Immobilise neck
 Check for other injuries
 Place in recovery position (if cervical spine intact)
 Monitor conscious level (AVPU)
Early evacuation. A patient who remains unconscious

from head injury requires early evacuation.
40 40
Burns
TRAUMA AND INJURIES

Burns can be life-threatening. Patients with significant
burns can suffer severe pain, fluid loss sufficient to cause
renal failure, infection leading to sepsis and smoke
inhalation.
Common causes of fire aboard are burning fat or
scalding water in the galley, fuel on a hot exhaust and an
electrical fault. An electrical burn is always full thickness
and often the damage is more extensive than appears at
first glance. Burns from chemicals or the sun can become
serious too.
To avoid such events wear an apron and shoes when
cooking in the galley or on a barbecue. In rough weather
avoid boiling water, use pots with lids such as a pressure
cooker or, even safer, employ the oven.
Do not pass hot cups of soup or tea by hand but in a

receptacle such as a washing up bowl. Do not work on a
hot engine. In the sun, wear a hat, shirt and sunblock.
4141
Burns
Initial treatment
TRAUMA AND INJURIES
1 Move the patient away from the source of the heat. If

the clothes are on fire then smother the flames with a
blanket or ‘drop and roll’ (this is less easy at sea).
2 Remove any non-adherent clothing and jewellery near
to the burn.
3 Remove heat from the area by cooling.
This is best done with cold water but not ice. A burnt
extremity should be plunged into cold water for 20
minutes or more. This action removes heat, excludes air
and offers some pain relief. A large quantity of water
may be required so, on the ocean, this may mean using
seawater.
If the torso or trunk is burnt and plunging into water
is not possible then use wet towels and refresh the cold
water frequently. A chemical burn must be flushed with
water for at least 15 minutes.
42 42
Burns
4 Cover the burn to reduce the amount of fluid loss and
TRAUMA AND INJURIES

the chance of contamination leading to subsequent
infection.
This is best done with a hydrogel burns dressing that
will cool the burnt skin, thus reducing pain, and provide
a sterile dressing that conforms to the contours of the
body. If such dressings are not available use clingfilm.
Lay it on the burn and lightly apply a bandage to hold
it in place.
If a hand is burnt or scalded, wrap each finger
individually with dressing or clingfilm to prevent them
sticking together and place the whole hand in a clean
plastic bag.
Do not apply any creams, oils or butter. Blisters should

be left intact as they act in the same way as a dressing,
keeping out air and helping to prevent infection.
Later assessment
After 48 hours check for signs of infection such as increased
pain, odour, excessive exudate (pus), redness or fever.
Change the dressing if needed. If it is dry and comfortable
leave undisturbed for 5 days. Thereafter change the
dressing every 3 to 5 days until the wound is healed.
The depth of a burn may be described as superficial,
partial thickness or full thickness. Superficial burns give
4343
Burns
rise to reddened skin and are painful and tender to touch.

TRAUMA AND INJURIES
With appropriate treatment subsequent scarring is absent

or minimal. With a partial thickness burn the skin is red
and blistered and extremely painful and tender.
A full thickness burn can exhibit leathery, sometimes
blackened skin. The skin and underlying tissue such as
muscle and tendon may be charred. The full thickness
burn is not painful as the nerve endings have been
destroyed. However, the area of skin around the burn can
be very painful. Partial and full thickness burns heal but
with debilitating scarring and contractures.
The Rule of Nines

The area of a burn can be estimated by the Rule of Nines.
4.5% 4.5%
9% 9%
4.5% 4.5% 4.5%

9%
9%
1%
9% 9% 9% 9%
44 44
Burns
Each region of the body as illustrated is equivalent to 9%
TRAUMA AND INJURIES

of the body surface area. The palm is equivalent to 1%
surface area and the area of an open hand with fingers
splayed around 4%. These figures will help the skipper
estimate the body surface area burnt.
Smoke inhalation
Smoke inhalation can be serious. It may be suspected
if the patient has a reddened, blistered face, burnt
eyebrows or soot at the back of the mouth. Symptoms
include hoarse voice with rapid, difficult, noisy
breathing. The patient may initially appear well before
later deterioration. Sit the patient upright as the lungs
work more efficiently in this position. Administer
oxygen if you have any.
AT A GLANCE – Burns
 Remove from source of heat
 Cool the burn
 Dress the burn
 Give pain relief
 Give fluids
 Give antibiotics if infected
Early evacuation. Patients who suffer burns to the face,

hands or genitals, deep burns or those covering more
than 5% body surface area or significant symptoms of
smoke inhalation require early evacuation. So do all
children who suffer burns.
4545
Hypothermia and drowning
TRAUMA AND INJURIES
Hypothermia
Hypothermia does not require immersion. It can occur
after a prolonged period on deck. Symptoms include
irritability, lethargy, slurred speech, loss of memory and
eventually an unresponsive state leading to coma.
The sufferer must be brought below deck for warming.
Wrap the patient in warm covers and a foil blanket and lie
them in a bunk in the recovery position. Someone should
lie down alongside to help the warming process. If the
patient is conscious offer a hot sweet drink.
Drowning
The possibility of drowning is a risk for all those who go
to sea. People who are drowning do not cry out or wave.
In the brief time the mouth is above the water, the need
to breathe takes priority over yelling. If they raise their
arms to wave they sink further, so they don’t. It has been
estimated that in 10% of cases when children drown, an
adult will actually watch them drown having no idea it is
happening.
With drowning, just as with head injury, prevention
is of paramount importance as treatment is not always
successful in the event of either. Prevention is simple: wear
a life jacket and fasten the crotch strap. This applies to
everyone on the water, paddleboarders, kayakers, dinghy
sailors, motor boaters, yachtsmen. Of those people who
drown not wearing a life jacket, it is thought that around
85% would have survived if they had been wearing one.
Sailors should wear a life jacket, harness and tether
when sailing at night, in heavy weather (even when
resting below), working forward of the mast, when alone
on deck and when performing a tricky manoeuvre such
46 46
as shortening sail. It is wise, and indeed law in some
TRAUMA AND INJURIES

countries, to wear a lifejacket in a dinghy. The return trip
in the dark from a meal ashore represents a risk and crew
have drowned in that short trip. The modern life jacket is
so light and easy to wear there is an argument to wear one
all the time when aboard.
What to do about drowning
Retrieve drowned
victim to cockpit
Assess ABC
No signs of life ABC satisfactory
Remove
Start CPR
wet clothes
Wrap in
warm blanket
Place in bunk in
recovery position
with a companion
4747
Treatment
TRAUMA AND INJURIES
1 Once the drowned patient has been hauled back

aboard or to the shore, assess them for signs of life and
check for A, B and C: Airway, Breathing and Circulation
(see page 13).
2 If these are satisfactory then roll the patient into the
recovery position. There is no purpose in performing
the Heimlich manoeuvre or abdominal thrusts to
empty the lungs – if the patient is alive the volume of
water in the lungs will be quite small.
3 It is essential to remove wet clothing and then to wrap
the patient in warm covers; continue treatment as for
hypothermia.
4 If there is no sign of life then begin CPR with chest
compressions following Basic Life Support guidance
(see page 19). For cases of hypothermia and drowning
CPR should be continued for an hour, especially in
children.
Early evacuation. A patient resuscitated from cardiac

arrest from hypothermia or drowning requires early
evacuation.
48 48
Eyes
TRAUMA AND INJURIES

Eye injuries
The eye is well protected within the bony orbit and eye
injuries are rare. However, they can be caused by a flogging
rope such as a jib sheet or a flapping sail, for example. If an
injury is suspected because of pain and/or streaming tears
then examine the eye. Observe the pupil size compared
to the other eye.
Gently pull down the lower eyelid and evert the upper
eyelid. This may reveal a foreign body, red sclera, blood in
the eye behind the cornea and in front of the iris.
Extreme pain in the eye associated with a sensation
of a foreign body in the eye may suggest a corneal
abrasion. It will not be possible to see this at sea even
with a magnifying glass. A corneal abrasion will usually
heal within a few days. A penetrating eye injury may not
always be obvious. If a fishhook is caught in the eye, do
not attempt to remove it, but ensure early evacuation with
the patient.
4949
Eyes
Treatment
TRAUMA AND INJURIES
 Remove any foreign body that has not penetrated the

eye.
 A corneal abrasion is extremely painful and this can be
relieved by giving local anaesthetic eye drops inside the
lower eyelid.
 If the eye has been affected by a chemical thoroughly

wash the eye with water, preferably sterile, or with
saline for at least 15 minutes. If the chemical was alkali
then wash for longer.
 In all cases of trauma or chemical injury, the eye should
be treated with chloramphenicol antibiotic drops or
ointment to prevent infection; the latter lasts longer. In
severe cases, such as a penetrating injury, administer
oral antibiotics as well.
 Eye injuries are painful so analgesia, including local
anaesthetic eye drops and oral painkillers, should be
given.
50 50
Eyes
Eye disorders
TRAUMA AND INJURIES

Contact lenses can cause problems at sea. Wearers may
suffer dry eyes, conjunctivitis and corneal abrasion. The
treatment is to stop wearing the lenses and give artificial
tears or chloramphenicol ointment. A lens can be lost
under an eyelid and must be retrieved – most wearers will
have had to do this before and will know how.
Sea blindness is similar to mountaineer’s snow
blindness. It is caused by damage to the cornea from
UV rays. Patients suffer extreme pain in the eye and
photophobia. Prevention by wearing good quality
sunglasses is best. Otherwise administer local anaesthetic
drops and antibiotic ointment.
A bright red subconjunctival haemorrhage looks
alarming but is painless and does not affect vision. No
specific treatment is needed. So called ‘red eye’ can be
serious, especially if painful, and may be due to acute
glaucoma, acute iritis, or orbital cellulitis (infection).
Early evacuation. A penetrating eye injury, a painful

red eye without trauma and acute blindness require
early evacuation.
5151
Ears
TRAUMA AND INJURIES
Outer ear infection or otitis externa, sometimes called

swimmer’s ear, is the most likely affliction to occur on a
boat. It appears as a painful ear with discharge, sometimes
with pus. Pulling the earlobe is painful. Avoid further
swimming. Rinse the ear with sterile water or vinegar. If
symptoms persist, use antibiotic ear drops at the rate
of 4 drops into the ear every 6 hours for up to a week.
Chloramphenicol eye ointment or drops may be used if
specific ear drops are unavailable.
To have a buzzing insect trapped in the ear is extremely
distressing; it drives people crazy. Treat it by administering
a few drops of olive oil into the ear. This will cause the
death of the insect. Then remove the corpse carefully with
tweezers.
52 52
.
Nose
TRAUMA AND INJURIES

A nosebleed can be alarming. The majority come from
the anterior (front) part of the nose and respond well to
simple treatment. A bleed from the back of the nose is
more difficult to treat. The blood may be bright red, which
signifies active bleeding or dark with clots.
Treatment
1 Sit the patient upright or, if they are unable to do this
comfortably, in a reclining position.
2 Squeeze the anterior, soft, part of the nose between
index finger and thumb for at least 15 minutes, the
patient may be able to do this themselves.
3 This will usually control the bleeding but if it continues
then repeat the manoeuvre for another 20 minutes.
If the bleeding continues even when the nose is being

pinched, it indicates a bleed from the posterior or back
part of the nasal cavity. If it fails to abate, then packing the
nose may be necessary.
1 Cut a strip of clean cotton cloth, up to a metre may be

needed. Cover the strip with petroleum jelly (Vaseline)
or an antibiotic ointment.
2 Pack it gently into the nose, starting at the middle of the
strip so that, when packed, both ends protrude from
the nostril. Use tweezers and a piece of wood such as
a fine chopstick or a twig. Alternatively pack the nose
with a tampon.
3 The nose contains bacteria so give antibiotics (amoxy
cillin or azithromycin) until the pack is removed.
4 Leave the pack or tampon in situ for one or two days.
5 If bleeding recommences, gently blow the nose to
remove clots and then repack.
5353
Nose
Another more specialist approach to stop the bleeding

TRAUMA AND INJURIES
from the back of the nose is to use a urinary catheter. One

should be in the medical kit for treating acute retention of
urine. The Foley type catheter should be introduced into
the nose as far as the back of the throat. The tip will be
visible through the open mouth. Inject into the balloon 10
or 15ml of air and gently withdraw the catheter through
the nose until it impacts upon and obstructs the bleeding
area.
The deformity of a broken nose may be obvious after
facial trauma. It is sometimes possible immediately to grab
the nose and straighten it. If this painful procedure proves
unsuccessful then do not persist, leave it until proper
treatment can be given ashore. A broken nose alone or a
nosebleed are rarely reasons for early evacuation.
54 54
Teeth
TRAUMA AND INJURIES

Visit a dentist before setting out on a long voyage. In the
medical kit include a dental mirror, tweezers, a first aid
dental kit such as Dentanurse and a temporary filling
material like Cavit.
Toothache without infection is usually caused by a
cavity (a hole in the enamel). The treatment is to dry the
hole and apply oil of cloves (eugenol) then fill the hole
using a temporary filling material. Semi-melted candle
wax can suffice.
A tooth abscess gives rise to an intense throbbing
pain and tenderness, sometimes with swelling of the
face or neck. Antibiotics must be given (metronidazole
and co-amoxiclav). That may be enough but if the pain is
associated with an old filling, remove what you can and
clean the resultant hole with antiseptic. Leave the hole to
drain.
If a tooth is knocked out by facial trauma, it should be
replaced in under an hour so that it may survive. Handle
the tooth by the crown. Gently rinse the root but do not
abrade it. To keep the tooth, perhaps for another attempt
to implant it, store it in a container with milk. Should the
tooth socket continue to bleed, roll up a piece of gauze,
place it in the empty socket and ask the patient to bite on
it for 20 minutes or so.
5555
Skin
TRAUMA AND INJURIES
It is important for everyone on board take care to protect

their skin.
Sunburn
Sunburn can become quite debilitating so protective
measures must be taken. Do not rely entirely on sunblock,
which can become diluted by sweat or washed away
when swimming. Limit the time spent in glaring sun. In
fierce sun, wear a long-sleeved shirt, a wide-brimmed hat
and long trousers. Sunglasses will protect against glare and
prevent sea blindness (sunburn of the cornea and similar
to snow blindness). If a person becomes severely sunburnt
move them into the shade and give fluids to maintain
hydration. Apply a cold compress to the affected area. If
needed give pain relief such as paracetamol together with
an NSAID such as ibuprofen. Calamine lotion may sooth
sunburnt skin. In severe cases hydrocortisone 1% cream
may help.
Rashes
Skin rashes may be due to infection, allergic reactions
or inflammation. An allergic rash is red and sometimes
urticarial, meaning that the skin is raised and swollen (also
called hives). The common causes on a boat are drugs
and chemicals. Remove the probable cause and stop any
suspected drug. Antihistamines will help either applied to
the skin (diphenhydramine cream, such as Benadryl) or
taken orally (chlorpheniramine tablets, such as Piriton).
56 56
Skin
Impetigo
TRAUMA AND INJURIES

Impetigo is a staphylococcal skin infection. It starts with
small, infected blisters that become pustular, break down
into running sores and leave crusty patches (like corn
flakes on the skin). To treat, clean the affected skin with
antiseptic solution, dry the area and apply antibiotic
cream. If infection is extensive also give oral antibiotics
such as flucloxacillin effective against staphylococci or, if
penicillin allergic, clarithromycin.
Eczema
Eczema (dermatitis) is a common, chronic condition and
the patient is usually aware of the diagnosis. Patches of
skin become red and scaly. If the patch is wet attempt to
dry it and if dry then use moisturiser. In acute severe cases
hydrocortisone 1% cream will help.
Shingles
Shingles causes an area of skin on one side of the body
to become painful. This pain is followed soon after by a
vesicular (small blisters) rash. There is no specific treatment
and the rash should settle in a week or two.
Blisters
Blisters are best avoided and another example where
prevention is better than cure. To protect the hands wear
gloves when working the anchor, chain, ropes or helming
in rough weather. Wearing shoes of some sort is wise as
feet can be injured and blister when on deck or below.
At the first sign of chafing protect the part and cover
with a blister dressing. A doughnut dressing can be
constructed by cutting a hole in the dressing immediately
over the part.
5757
Skin
TRAUMA AND INJURIES
Small blisters are best left alone. Larger blisters can be

pricked with a sterile needle and the fluid milked out. Leave
the redundant skin and protect with a dressing, preferably
a hydrogel burns dressing or hydrocolloid dressing.
58 58
Frostbite
TRAUMA AND INJURIES

Frostbite signifies that the skin and maybe the deeper
tissues are frozen. This is most likely to occur at high
latitude but with careful attention can usually be avoided.
Frostbite occurs on the extremities, the hands, feet,
nose, ears and, in bad cases, the cheeks. The skin will be
white, sometimes with a purple hue. The affected part
feels cold and hard like wood and will eventually blister.
Treatment
 Protect the area from further cold and from trauma, and
keep the patient warm, hydrated and fed.
 Administer a low dose of aspirin 75mg and ibuprofen
400mg three times daily. This medication will help the
pain and the circulation.
 Smoking and alcohol should be avoided.
 Do not rub or massage the affected part – this will
cause further trauma.
 To rewarm the extremity, such as a hand, place it in
warm water of about 40°C (but not more than 43°C)
with some antiseptic added. This may take an hour.
 When the hand has thawed, it will become red,
throbbing, painful, swollen and blistered.
 If there is no prospect of early evacuation of the patient
it may be necessary to repeat the above.
5959
Infections
ACUTE MEDICAL ILLNESS
Infections are caught more readily in port than at sea.

They can be viral, bacterial, fungal and parasitic. Not
all infections require antibiotics. Viral infections such
as influenza, norovirus enteritis or coronavirus do not
respond to antibiotic therapy.
Antibiotics may not be needed for an unclean open
wound, abrasion or laceration. Such wounds should
be cleansed with antiseptic solution, have any foreign
material removed, cleansed with antiseptic again and
kept dry. If the wound develops surrounding redness and
swelling, indicative of infection, antibiotic therapy should
be given.
If antibiotics are not available, supportive measures can
help. Wounds, ears and eyes can be washed with boiled
salt water (two cups of cooled boiled water with one
teaspoon of salt and a pinch of baking soda). Abscesses can
be soaked in warm saline or a poultice and encouraged to
discharge pus. A person with a chest infection can sit up,
energetically cough up phlegm, breathe deeply and take
in a steam inhalant.
It is a good idea to take antibiotics on any offshore
voyage. When deciding on an antibiotic, try to give the
best one for the task. A broad-spectrum antibiotic such
as ciprofloxacin will treat severe bacterial gastroenteritis,
and co-amoxiclav will treat pneumonia or a urinary tract
infection. A penicillin such as flucloxacillin or amoxicillin
will treat skin infections. Non-penicillin antibiotics
(clarithromycin, doxycycline) must be administered for
those with penicillin allergy (see box). An antibiotic for
anaerobic infection (metronidazole) is useful for targeting
mouth infections and dental abscesses.
A more comprehensive list of antibiotics can be found
in the table on page 96.
60 60
Infections
Penicillin allergy is a potential and dangerous

problem and should always be ruled out where
possible. The patient often knows of their allergy. In
such cases use a non-penicillin alternative even if
considered less efficacious.
Specific infections such as chest or urinary
infections are tackled in their own sections of the book
(see page 66 and 77).
Antibiotics and antifungals

BODY INFECTION DRUG
SYSTEM (penicillins highlighted
in bold – beware: may
cause severe reaction in
the allergic)
Abdomen Bacterial Ciprofloxacin,

gastroenteritis, Metronidazole
bloody
diarrhoea
Chest Pneumonia Amoxicillin,

Co-amoxiclav,
Clarithromycin,
Doxycycline
Ears Otitis externa Sofradex ear drops,

Otomize ear spray,
Ciprofloxacin
Eyes Bacterial Chloramphenicol eye

conjunctivitis drops/ointment
Dental Metronidazole,
Gingivitis, Doxycyline,
periodontitis, Amoxicillin
dental abscess
6161
Infections
BODY INFECTION DRUG

SYSTEM (penicillins highlighted

in bold – beware: may
cause severe reaction in
the allergic)
Skin Impetigo, Amoxicillin,

cellulitis, Flucloxacillin,
wound Co-amoxiclav,
infection, Clarithromycin,
infected burn, Co-trimoxazole 1%
Athlete’s foot cream
Urine Cystitis, Co-amoxiclav,

pyelonephritis Ciprofoxacin
Genital Sexually Doxycycline,

transmitted Co-trimoxazole 1%
infection, cream
pelvic
inflammation,
vaginal thrush
62 62
Anaphylaxis

Anaphylaxis is a severe allergic reaction that can occur in
response to an insect or jellyfish sting, drugs and some
foods such as peanuts. The patient will notice itchy skin
and eyes, a red rash, sweating, faintness from low blood
pressure, shortness of breath and wheezy breathing,
swelling of the lips, and constriction of the throat. This
may be followed by complete collapse with respiratory or
cardiac arrest.
Treatment
The patient may have an EpiPen device that can
administer adrenaline by intramuscular injection. It is
worth considering keeping an EpiPen in the ship’s medical
kit. The usual dose is 0.5mg or 0.5 ml of 1:1,000 adrenaline
solution. This may be repeated every 10 minutes but only if
the patient is not responding. The intramuscular injection
is best given in the front or side of the thigh. Timely
administration of adrenaline is critical and lifesaving.
In addition an antihistamine such as chlorpheniramine
20mg and a steroid, either hydrocortisone 100mg or
prednisolone 50mg, should be given although their onset
of action is much slower than adrenaline. A salbutamol
inhaler will help wheezing, give 4 puffs initially followed
by 4 puffs every 5 minutes. Give oxygen if available. If
complete collapse has occurred start CPR and administer
adrenaline.
Early evacuation. A patient who has suffered an

anaphylactic shock with collapse requires early
evacuation.
6363
Diabetes
Diabetes is a condition characterised by inadequate

production of insulin for the body’s metabolic needs. The
disease is becoming more common and the skipper must
be informed if one of the crew is diabetic.
Hypoglycaemia
Serious symptoms occur if the blood sugar is too low
(hypoglycaemia), which can happen if more insulin or
oral diabetic medication is taken than the food and sugar
intake requires. A diabetic who suffers seasickness with
loss of appetite and vomiting will have difficulty with their
diabetic control and may become hypoglycaemic.
The patient may become sweaty, appear confused and
aggressive like someone who is drunk, develop slurred
speech and eventually lose consciousness. Should this
happen when on watch and helming, the consequences
for the boat will be serious, which is why the skipper must
know of the condition. The treatment is to administer
sugar with a sweet drink or a biscuit or similar.
Hyperglycaemia
High blood sugar (hyperglycaemia) can also occur
aboard a boat and is the result of too little insulin. The crew
member may have omitted an insulin dose, perhaps due
to feeling seasick and unwell. Symptoms include lethargy,
continuous thirst, passing large amounts of urine, rapid
breathing and eventually loss of consciousness. They will
become dehydrated so give regular sips of water. If it is
uncertain from the symptoms whether the patient has
high or low blood sugar then it is safer to administer sugar.
64 64
Diabetes
Anti-diabetic drugs

Familiarise yourself with a diabetic crew member’s
medication regimen as they can vary widely. Type 2
Diabetics may only require anti-diabetic drugs taken by
mouth. Type 1 Diabetics or those with poorly controlled
Type 2 diabetes require insulin. Types of insulin include
rapid acting (Novorapid, Humalog), short acting (Actrapid,
Humalin S), intermediate acting (Insulatard, Humalin I),
long acting (insulin glargine) and mixed (Humalin Mix25).
Insulin can be extremely dangerous if given without
appropriate training so exercise caution if helping a sick
diabetic to administer their insulin.
Early evacuation. An unconscious diabetic not

responding to treatment requires early evacuation.
6565
Chest disorders
Asthma
Unaccustomed exercise on a boat together with cold
weather and forgetting regular use of inhalers can set off
an asthma attack. Symptoms include shortness of breath
and wheezing with a fast respiratory rate. The patient will
be sitting up braced forwards. If they cannot complete a
whole sentence then their condition is severe.
Treatment
 Sit the person up and administer a bronchodilator, such
as salbutamol inhaler. The person is likely to have their
own inhaler.
 Give oxygen if available.
 A short course of a steroid such as prednisolone will
help an exacerbation of asthma.
 In extremis when facing imminent respiratory arrest,
inject adrenaline from an EpiPen. Such severe asthma
usually occurs in children.
Early evacuation. Patients suffering from severe

asthma, especially children, require early evacuation.
Chest infections
Chest infections manifest with a fever, shortness of breath,
a fast respiratory rate, cough, green sputum and maybe
some wheezing. Pleurisy can complicate a chest infection
and causes sharp pain when breathing in or coughing.
The patient should be sat up to help their breathing and
given antibiotics; amoxicillin is suitable, or doxycycline if
penicillin allergic. If the infection is severe with a breathing
rate of 40/min or more, give oxygen if available.
66 66
Chest disorders
Chest pains

Angina is cardiac pain due to reduced blood flow to the
heart muscle. The pain occurs on exertion but is absent
at rest. Most sufferers will have glyceryl trinitrate (GTN)
tablets that dissolve under the tongue. The question arises
whether those with heart disease and angina should take
the risk and sail any distance from shore.
The chest pain of a heart attack is severe – crushing
in nature, felt in the central chest and can radiate into
the jaw and down both arms, particularly the left arm.
A heart attack can be accompanied by pallor, sweating,
shortness of breath, faintness, nausea, anxiety and a sense
of impending doom.
Treatment
 To treat a heart attack give an aspirin (300mg tablet)
immediately and a further half tablet daily if medical
evacuation and further specialist treatment is not
feasible.
 Pain relief is important and may require morphine by
intramuscular injection. The patient may have GTN
tablets or a nitroglycerin spray and these should be
given early under the tongue.
 If available, oxygen can be given by face mask at a flow
rate of 5–10 litres/minute.
 This treatment of a heart attack has been summarised
as MONA (morphine, oxygen, nitrate spray, aspirin).
 If the heart attack leads to complete collapse then start
basic life support with chest compressions (as above).
 Failure of the heart to restart from an irregular rhythm
may require rapid defibrillation with an AED.
Occasionally severe acid indigestion with reflux can be

confused with cardiac pain. To help distinguish the two,
6767
Chest disorders
there is usually a history of reflux and the symptoms

respond to antacids such as Gaviscon or a glass of milk.
Early evacuation. A patient who has suffered a heart

attack will need further management and requires
early evacuation.
AT A GLANCE – Heart attack

 Administer drugs as per MONA
Morphine
Oxygen
Nitroglycerin spray (or sublingual tablets)
Aspirin
68 68
Epilepsy

Epilepsy is caused by abnormal activity in the brain. An
epileptic fit can be a scary experience to witness. There are
many different types of epileptic fit but for the purposes of
this handbook three will be described.
Absence seizures, previously called petit mal, occur
typically in children and young people. They manifest as a
period of vacancy and staring into space with a brief loss
of awareness. Episodes of petit mal may last 10 seconds
and can recur many times in a day.
Otherwise seizures may be focal or general and the
patient will exhibit uncontrollable jerking movements
of the arms and legs with loss of awareness or, in many
cases, loss of consciousness. Focal seizures result in the
involuntary jerking of the same part of the body, an arm
or a leg, with every fit. A general seizure, or grand mal
fit, can cause an abrupt loss of consciousness with body
stiffening, twitching and shaking. A grand mal fit can lead
to temporary loss of bladder control and to biting of the
tongue.
Treatment
The first line of treatment is to keep the patient safe and
prevent injury to them or other members of the crew.
 Do not attempt to restrain them or put anything in

their mouth. This manoeuvre was once advocated to
prevent tongue biting but is no longer advised.
 The post-ictal phase is when the fitting has ceased but
the patient has not regained full consciousness and
usually lasts less than half an hour. As soon as the fitting
has ceased, normally after a few minutes, place the
patient in a bunk in the recovery position.
6969
Epilepsy
Medication
People known to have epilepsy will usually take regular

anti-epileptic medication. Care should be taken not
to miss any doses and so increase the risk of seizures.
Epileptics may carry their own emergency drugs. A
common option is Buccolam (10mg of midazolam liquid
administered buccally that is inside the cheek) which will
help terminate a seizure. Another benzodiazepine used to
terminate fitting is diazepam 20mg administered rectally
or 10mg intramuscularly into the front or outer aspect
of the thigh. Intravenous injection is more effective but
difficult in a fitting patient.
Early evacuation. If this is a first fit or there are

multiple repeated fits or the patient has been injured
in a fit, then they require early evacuation.
70 70
Stroke

A stroke can be manifest as a weakness in a limb or
difficulty with speech and recognised using the acronym
FAST. Pain is not usually a feature.
Face – does one side of the face fail to move properly

and can the patient smile?
Arms – can the patient raise both arms above the
head and hold them up?
Speech – is the patient’s speech slurred and
incomprehensible?
Time – to call for help
Symptoms affecting the face, arms and speech can

indicate a stroke.
Treatment
The immediate treatment is to place the patient in the
recovery position with the paralysed side down and check
the airway. If the patient is unconscious then turn them
every 2 hours to prevent pressure sores (see Unconscious
crew, page 24). If still at sea after 2 days begin to move the
paralysed limbs passively. Even if the patient is apparently
unconscious and unresponsive, talk to them as they may
still be able to hear and understand.
In some cases early specialist treatment in a stroke
centre within 4 hours can reverse the adverse effects of
a stroke.
7171
Stroke
Early evacuation. A patient who has suffered a stroke

that has reduced their level of consciousness or caused

difficulty with breathing or with swallowing requires
early evacuation.
72 72
Abdominal disorders

Abdominal pain can be very difficult to assess even for
a professional. Intermittent pain or colic suggests bowel
contractions and may mean intestinal obstruction, which
is more likely if there has been previous abdominal surgery.
If the colicky pain is in the mid-abdomen it probably comes
from the small intestine and if in the lower abdomen from
the large intestine and colon. The latter can simply be a
sign of severe constipation.
Constipation
This is well known to afflict those on long sea passages.
It is better prevented than treated. Sailors should drink
plenty of water and eat fruit and vegetables. If these
are unavailable consider adding roughage in the form
of ispaghula husk (Fybogel), methylcellulose or similar.
For the constipated sailor start with a stool softener,
osmotic laxative (lactulose), then a gentle laxative (milk of
magnesia) and then a stronger laxative that stimulates the
colon such as bisacodyl or senna.
Diarrhoea
This may be caused by the ingestion of contaminated
water or food. Steps can be taken to minimise the chance
but, even when careful, avoiding diarrhoea cannot be
guaranteed. Avoid untreated tap water and drinks with ice
cubes. Be careful of raw vegetables, lettuce and salads as
well as under cooked meats such as chicken, burgers and
fish.
When suffering diarrhoea take plenty of fluids as
dehydration can creep up unnoticed and become a
problem. Water with electrolyte replacement powders or
tablets added in the prescribed dosage should be taken in
cases of prolonged diarrhoea. In the recovery period avoid
7373
Abdominal disorders
fats, caffeine, undiluted fruit juices and alcohol. Antimotility

drugs such as loperamide may help symptoms. Antibiotics

should be considered if the diarrhoea is bloody, associated
with a fever, severe abdominal pain or distension or if it
persists for two days or more. Ciprofloxacin is a good
choice.
Acid reflux
Known as heartburn, this is due to the reflux of acid into the
oesophagus and pharynx (throat). Antacids are effective
in curing or reducing symptoms. Chronic sufferers will
carry their own favourite medication. If no antacids are
available then milk is helpful or, as a last resort, a glass
of very cold water may afford some relief. Sleeping in a
semi-recumbent posture may help. Heartburn can mimic
genuine heart pain but can be differentiated from it by the
relief given by antacids.
Vomiting
Vomiting at sea is usually due to seasickness (see page
6) but can occasionally herald abdominal problems. If
the vomiting is ‘projectile’, a large amount that seems to
fire out under pressure, it may well be associated with an
intra-abdominal malady. Vomiting large volumes of foul
fluid, like dishwater, together with abdominal distension
suggests intestinal obstruction. Vomiting blood in any
quantity indicates bleeding from the oesophagus,
stomach or duodenum caused by inflammation or an
ulcer.
74 74
Abdominal disorders
Peritonitis

Inflammation and infection in the abdomen is a surgical
emergency. Initially local peritonitis occurs at the site of
the affected organ (appendix, bowel, gall bladder, etc)
but then becomes more widespread within the abdomen
as generalised peritonitis. As well as abdominal pain, the
patient is likely to have a fever and a tachycardia (fast
pulse).
1 Lay the flat of the hand on the abdomen over the site
of pain, for instance in the lower right quadrant over the
appendix if appendicitis is suspected.
2 Press gently and if this causes severe pain under the
hand, peritonitis is a possibility.
3 Now place the hand on the abdomen gently, as before,
and ask the patient to give a small cough. In a case of
peritonitis, this manoeuvre will also cause acute pain.
In some cases of advanced peritonitis the patient may be

reluctant to cough at all and the abdominal muscles will
7575
Abdominal disorders
be rigid and board-like. If the signs are uncertain and the

diagnosis remains in doubt repeat the examination after

an hour.
The precise cause of the peritonitis, whether appen
dicitis, perforated duodenal ulcer, diverticulitis or other
intra-abdominal disaster, is irrelevant as peritonitis cannot
be treated aboard and the patient will need to be removed
to a medical facility.
Early evacuation. Patients with persistent abdominal

pain for 6 hours or more, especially if associated with
projectile vomiting, a fever, abdominal distension and
signs of peritonitis require early evacuation.
76 76
Urinary disorders

Infections
Urinary infection in the bladder causes cystitis. Symptoms
include pain on passing urine, frequency (increased rate
of urination), urgency (a need to go immediately), cloudy
foul-smelling urine and dull pain in the central lower
abdomen.
To reduce the chances of developing cystitis, drink
plenty of fluids and monitor your intake by watching
the colour of urine. Respond quickly to the urge to pass
urine, do not ‘hang on’. This reduces the time that urine is
stagnant in the bladder and thus more likely to become
infected. Taking cranberry juice may help prevent cystitis.
Cranberry juice may work by making the urine acidic and
by inhibiting how bacteria adhere to the urinary tract cells.
Treatment of an established urinary infection
requires antibiotics. A three-day course usually suffices.
Co-amoxiclav or ciprofloxacin are suitable drugs along
with copious amounts of oral fluids.
Acute urinary retention

Acute urinary retention is the sudden inability to pass urine.
It can occur in men of a certain age with prostatism, which
includes many sailors. An enlarging prostate will lead to
a poor urinary stream, frequency, urgency and nocturia
(the need to go at night) and sometimes urinary retention.
Certain drugs such as antihistamines and anticholinergics,
which occur in drugs for seasickness, may contribute to
making retention more likely. An unconscious patient may
develop retention as can those with a severe urinary tract
infection.
7777
Urinary disorders
Treatment
The treatment of acute urinary retention is to pass a

urethral catheter into the bladder. Any boat that is going to
sail long distance offshore with crew members who may
be susceptible to retention must take aboard a catheter.
1 Before inserting the catheter, wash your hands and

wear sterile gloves.
2 Squirt lubricating gel onto a sterile surface such as the
sterile glove packet.
3 Wipe the urethral entrance and head of the penis with
antiseptic. For a right-handed person, hold the penis
vertically in the left hand with some traction.
4 Take the catheter with the right hand about 12cm from
the tip, lubricate it with the sterile gel and insert it,
gently advancing it up the urethra. The draining end of
the catheter should be held over a container of at least
1 litre capacity.
5 If resistance is met, increase the traction with the left
hand and ask the patient to give a small cough to help
ease the catheter into the bladder.
6 When urine flows, the catheter is in place but must be
advanced a further 5 to 10cm.
7 Now inflate the balloon with 10ml of sterile or bottled
water and note that volume. Should pain occur on
inflation the catheter may still be in the urethra rather
than properly in the bladder – deflate the balloon and
advance the catheter further before trying again.
The catheter can be removed after aspirating the 10ml of

water from the balloon. Removal should be covered with
antibiotic treatment continued for 48 hours.
78 78
Gynaecological disorders

Pregnancy is no reason not to go sailing, but preferably
stay near to land. It would be unwise to set sail at 35 or
more weeks pregnant. If the mother is susceptible to
seasickness, pregnancy may make it worse. The two main
emergencies that would be of great concern on a boat are
miscarriage and ectopic pregnancy.
Miscarriage
Among those who know they are pregnant, miscarriage
occurs in around 1 in 8. Women suffering a miscarriage
are not always aware that they are pregnant although
a pregnancy test will usually confirm it. When a woman
begins to miscarry, the pregnancy test will remain positive
for two weeks, even sometimes up to a month.
The main symptom of miscarriage is vaginal bleeding
with red blood and clots. The bleeding may come and
go over several days. Light vaginal bleeding can occur
during the first trimester (first three months) of a normal
pregnancy and must not be confused with a miscarriage.
The common symptoms of pregnancy such as morning
sickness and breast tenderness may disappear. The
bleeding is often associated with cramping lower
abdominal pain.
Treatment
Miscarriage may require pain relief and fluids to replace
loss. Some drugs such as ergometrine and oxytocin can
reduce bleeding in a miscarriage but are unlikely to be
available. Ideally the patient should be taken ashore in
case of heavy blood loss.
7979
Gynaecological disorders
Ectopic pregnancies
An ectopic pregnancy occurs when a fertilised egg

implants itself outside the womb usually in one of the
fallopian tubes. Symptoms develop between the fourth
and twelfth weeks of pregnancy. Lower abdominal pain
on one side which can be persistent or intermittent is
the main symptom. This pain may be associated with a
brownish watery vaginal discharge rather than red blood.
Changes in bladder and bowel patterns can occur but this
may happen in a normal pregnancy too.
Rupture is a very serious complication of ectopic
pregnancy. This will cause a sudden and severe pain
in the abdomen along with dizziness or fainting from
low blood pressure. Blood is lost into the abdomen and
causes generalised tenderness especially in the lower
part, symptoms that are indistinguishable from peritonitis.
Vaginal bleeding may be minimal or absent.
Treatment
Lie the woman down and raise her legs, treat with fluids
and give pain relief to help relieve shock.
Early evacuation. A woman with a ruptured ectopic

pregnancy requires early evacuation.
80 80
Bites and stings

Insects
Insect repellents such as diethyltoluamide (DEET)
are extremely helpful. DEET should be applied in a
concentration of at least 50% when it will last several
hours. DEET 100% has been used and can last 12 hours but
DEET 50% may be preferable. Much lower concentrations
of 10% should be used for children under 12 years old. Do
not apply insect repellent to broken skin.
Highland midges (Culicoides impunctatus) are found
in the north of the British Isles, especially Scotland, in
Scandinavia and Northern Europe. The midge is prevalent
from late spring to late summer. The bite can be felt as a
sharp prick often followed by an urticarial or raised skin
swelling that is itchy and irritates. Midges prefer humid,
damp conditions and are most active at dawn and dusk.
Rain does not deter them nor does darkness. They do not
thrive in hot, dry weather and tend to disappear if the
wind speed approaches 10 mph.
To prevent attack by midges wear clothing so as to
minimise the area of vulnerable exposed skin. Some
sufferers go as far as to wear a midge net to cover the head.
Midges will enter boats and tents so placing a midge or
mosquito net across the companionway will help in the
battle to keep them out.
Stings from wasps, bees and hornets cause pain,
a stinging sensation, a red swelling and a rash. (Similar
symptoms occur with stings from jellyfish and from
certain fish such as the weever fish and stingray, both
present in shallow waters.) A sting from any of these
creatures can be intensely painful.
8181
Bites and stings
Treatment
1 Do not touch the sting but remove it as soon as

possible. This can be done by picking it out with
tweezers. Otherwise cover the sting area with shaving
cream or flour and scrape it off. This should remove the
stings.
2 Apply a cold compress and sodium bicarbonate to
ease symptoms. You can also soak the area in hot water,
as hot as bearable – sea water will do. This causes the
breakdown of venom.
3 Wash the area and apply a sterile dressing to any
wound.
4 Local anaesthetic or ibuprofen gel will help the pain.
Itching and irritation should respond to antihistamine
(diphenhydramine 25mg, chlorpheniramine 4mg). If the
inflammation is severe then consider hydrocortisone
1% cream.
Portuguese man o’war

This is not strictly a jellyfish. It floats on the surface of the
ocean and travels passively before the currents and wind.
For this reason the creature can be washed up on the shore
in numbers. It can still sting when grounded on a beach so
do not handle one. It dangles venomous tentacles that are
typically 10 metres long or more, even up to 30 metres.
The sting is painful and leaves red welts and blisters on the
skin where the tentacle has been in contact.
Treatment
1 Remove embedded tentacle fragments with tweezers.
2 Rinse with vinegar and then apply heat using hot
water, as hot as bearable, which should be effective in
reducing symptoms.
82 82
Bites and stings
3 Hydrocortisone 1% cream will help soothe inflamed,

irritated skin. If the skin reaction is severe and
prolonged then consider oral prednisolone starting
with a dose of 60mg, reducing daily by 10mg.
Administration of painkillers (paracetamol with
ibuprofen) and antihistamines (diphenhydramine or
chlorpheniramine) may help.
Box jellyfish
There are many species of these, some with tentacles up
to three metres long, but the dangerous one, the Irukandji
jellyfish from Australia, is tiny at only one cubic centimetre
in size. A sting is extremely painful not just at the sting site
but in the abdomen, back and limbs as well. The sting can
be fatal.
Treatment
The Australian Resuscitation Council recommends treating
the sting with vinegar as this promotes the discharge
of venom and prevents untriggered stingers from
discharging. The patient will require morphine injection
for the extreme pain, antihistamines for inflammation and
even antihypertensives to control blood pressure.
Any of these stings can initiate anaphylaxis. The onset
of symptoms such as skin redness, wheezy breathing,
swelling of lips, eyes and throat, tachycardia and faintness
calls for immediate treatment (see page 63).
Bites
It is best to avoid bites, especially those from a shark,
moray eel, barracuda, crocodile or dog. Apart from the
obvious tissue damage, animal bites can lead to infection.
8383
Bites and stings
Treatment
1 If unfortunate enough to get bitten, then wash the

wound with soap and hot water.
2 Stop any bleeding with direct pressure (see page 29).
3 Soak the wound in hot water, as hot as bearable, for up
to 90 minutes.
4 Do not attempt to suture a bite, leave it open.
5 Cover the wound with a sterile dressing and check daily
for infection.
6 If infection occurs treat with a broad spectrum
antibiotic (co-amoxiclav or ciprofloxacin). Everyone on
board should be up to date with tetanus injections.
84 84
Heat

Heat exhaustion occurs with exertion in a hot climate.
It is more common in the elderly, children, the less fit
and those with a level of dehydration. Symptoms include
dizziness, nausea, thirst, headache and muscle cramps.
The temperature may a little raised but is often normal.
The pulse will be rapid and the blood pressure low.
It is important to recognise heat exhaustion as it can
progress to potentially fatal heat stroke. Treatment is to
provide shade, splash with water, fan and rehydrate the
sufferer.
Heat stroke can be fatal. The heat-losing mechanisms
of the body fail and the temperature rises rapidly. As well
as the symptoms of heat exhaustion, the patient may have
a reduced level of consciousness or even be unconscious.
The temperature may reach 40°C or more. The pulse and
respiratory rate will be raised and blood pressure low.
There may be shivering or fitting, the so-called febrile fit.
Treatment requires aggressive manoeuvres to reduce
the temperature by fanning the patient while spraying
and splashing with cold water. Total immersion in cold
water will help. Apply ice to the neck, armpits and groins
and, if available, administer oxygen at 6 litres/minute.
8585
Dehydration
Dehydration can readily occur on a boat, often initially

unrecognised. When crew are cold, tired and sick, fluid
intake is poor. Fluids can be lost through vomiting,
sweating in hot climes and diarrhoea. To prevent
dehydration, monitor the colour of urine. Should the urine
become darker, do not ignore it, take a drink. An active
sailor will require about two litres of water a day.
A combination of poor intake of fluid and excess loss
will rapidly lead to a state of dehydration. Symptoms
begin with weakness, lethargy, headache and eventually
collapse.
Treatment
The treatment is to take fluid and electrolytes in copious
amounts. Proprietary electrolyte solutions are best. If these
are not available make up your own. The formula is eight
flat teaspoons of sugar to one teaspoon of salt in one litre
of clean (boiled or bottled) water. Two to four litres may be
needed in the early stages of treatment.
86 86
Tropical diseases

Consider the countries that may be visited and arrange
appropriate prophylaxis and medication. This will mean
leaving adequate time for inoculation as some vaccinations
cannot be given together and may have to be staggered.
For instance, if the MMR vaccine has just been given then
a wait of four weeks is recommended before a yellow fever
vaccination can be administered.
Certain vaccines such as MMR (mumps, measles,
rubella), pneumococcus, meningococcus and others are
nowadays given in childhood. For travel in the tropics,
vaccinations are available for the bacterial diseases
typhoid fever and typhus and similarly for viral diseases
such as yellow fever, hepatitis A and B. Take expert advice
on what is required for the places due to be visited.
Malaria
Malaria is caused by the Plasmodium parasite and
spread by the Anopheles mosquito. Malaria is a serious
and sometimes fatal disease. There is not yet a vaccine.
Prophylactic antimalarial drugs are not 100% guaranteed,
so in affected areas, efforts must be made to avoid
mosquito bites.
The anopheles attacks at night so maximum
precautions must be taken between dusk and dawn.
Wear long sleeves and long trousers. Place mosquito
netting over the companion way, hatches and port holes.
Consider anchoring in deeper salt water away from the
shore. Use insect repellent DEET at 50% strength (less for
children).
Antimalarial drugs should be taken before setting out
and continued until safely away from the malarial area.
The different antimalarial drugs vary in that some must
be taken two weeks before reaching the malarial area
8787
Tropical diseases
and continued for a month after leaving while others can

be taken for a shorter time. Some antimalarials are taken

daily and some weekly.
In some areas of the world resistance to certain drugs
has occurred, so specific drugs are recommended for
particular areas. Drugs can have side effects, especially for
pregnant women, so take expert advice before setting sail.
If malaria is contracted, symptoms may not appear for
many weeks and often after the patient has come home.
Any symptoms that occur on return from a malarial region,
whatever those symptoms are, must be considered due to
malaria until proved otherwise. Do tell the doctors of your
voyage, do not leave them to guess.
88 88
Poisoning

Poisons can be ingested, inhaled or injected through the
skin, for instance by a bite or sting. For swallowed poisons,
do not try to induce vomiting, which can cause more
harm. For ingested fluids, such as acids, alkalis, detergent
or bleach, administer copious fluids for example water or
preferably milk. If ingested pills or drugs lead to loss of
consciousness then start Basic Life Support (see page 19).
The greatest danger when it comes to inhaling a
poison on board is carbon monoxide (CO) and to a lesser
extent chlorine. Carbon monoxide can be given off by a
poorly-maintained engine, generator or stove for heating
or cooking, particularly if the exhaust or flue are leaking.
The problem is worse in confined spaces with poor
ventilation, like a boat.
Carbon monoxide is colourless and odourless so
the patients, often asleep, are unaware of the gas and
death can ensue. It is therefore unwise to sleep aboard a
stationary vessel with an engine or heater running.
Patients suffering from CO poisoning exhibit lethargy,
headache and loss of consciousness. The lips will be cherry
red and the skin flushed.
When treating a patient of CO poisoning be sure to
avoid the gas yourself. Move the patient to the deck for
fresh air and check the airway. If available, administer
oxygen at 6 litres per minute. If the patient is unconscious,
place in the recovery position and if the patient has a fit,
treat as for grand mal epilepsy (see above).
Chlorine can be given off when a battery bank floods
and battery acid leaks. Sealed batteries are safer. Chlorine
poisoning can also occur, particularly in children, from the
ingestion of household cleaning materials.
8989
Whether to evacuate a sick or injured sailor is not always
MEDICAL EVACUATION
an easy decision. Prior discussion with a medic to talk

through the options can be very helpful. If within range
of the coast, consider speaking to a local doctor onshore
by telephone. Otherwise advice can be given by a medic
via an MRCC such as Falmouth or else by a telemedicine
doctor.
If near a harbour simply alter course to land the patient
ashore and call an ambulance. It may be possible to call
ahead for an ambulance either directly or through the
Harbour Master so one is waiting on the quayside.
Transfer of a patient from boat to the quay, to a lifeboat,
to a helicopter or to a ship is hazardous and must be done
with care preferably by experts whether lifeboat men or
coast guards.
If the vessel is further offshore and urgent evacuation
is required then a lifeboat may be requested. The lifeboat
crew will direct the transfer and many are trained as
paramedics.
Should the vessel be further out to sea a helicopter can
be sent. The range for helicopter rescue is about 120nm
and when it arrives there is little hover time to transfer the
patient, so be ready. Take instructions from the helicopter
crew. Steer the boat on a straight course at a steady
speed; for proper control, the engine is preferable to sails.
Communicate with the helicopter crew via VHF.
90 90
Medical evacuation
Rescue is usually from the port side of the boat into the MEDICAL EVACUATION
starboard side of the helicopter with the wind on the port
bow. The helicopter crew will drop a hi-line. Allow it to
earth in the water or on the boat. Do not attach it to the
boat or let it tangle with the rigging. Coil the hi-line into
a bucket. A winchman will descend the line – be sure to
follow his instructions.
9191
Medical evacuation
MEDICAL EVACUATION
In rough weather it may be safer to recover the patient

from the liferaft trailed astern. A patient that has been
in the water for a period of time will be raised into the
helicopter in a horizontal position. This is to prevent the
flood of blood into the dependent legs that will lead to
low blood pressure and even cardiac arrest.
When far out at sea it may be possible to transfer the
patient to a merchant vessel or liner that may have been
diverted by an MRCC. The ship may carry medical facilities.
Such a transfer can be very hazardous and difficult to
achieve. The sides of a ship are high compared to a yacht
and the patient will not be able to climb a rope ladder or
scrambling net. The risk of the yacht smashing against the
ship and damaging her rig or her hull are high. If possible
it is preferable for the ship to launch a boat.
92 92
Reasons for early or urgent
medical evacuation
MEDICAL EVACUATION
The ease with which a patient can be evacuated will
depend on the severity of the medical condition and the
position of the vessel. Clearly evacuation from mid-ocean
or high latitudes will present more difficulties.
Medical conditions for which evacuation is

recommended
Bleeding that is persistent and uncontrolled
Burns and smoke inhalation
CPR survivors (anaphylaxis, heart attack, hypothermia,

drowning)
Epileptic fit if it is a first fit or fits are persistent and

uncontrolled
Fracture of pelvis or thigh with blood loss or reduced

circulation to the limb
Fracture of multiple ribs leading to respiratory distress
Fracture of the jaw
Heart attack
Penetrating eye injury
Peritonitis
Ruptured ectopic pregnancy
Severe asthma, especially in children
Stroke with compromised breathing or swallowing
Unconsciousness that is persistent following head injury or

acute medical illness such as diabetes or stroke
9393
Medical kit
MEDICAL EQUIPMENT
Assorted plasters
Bandages (crepe, triangle, sling, finger, adhesive)
Cling film
Clinical thermometer
AED defibrillator
Dental mirror
Dental filling (Cavit), dental first aid (Dentanurse)
Dressings (non-adhesive, sterile, hydrocolloid burns

dressing, cling film)
Elastic strapping
Eye bath, dressing and eye patch
Finger bandage and applicator
Head torch
Intravenous fluids and giving set
Magnifying glass
Needles and syringes
Scalpel and blades
Scissors, forceps, safety pins
Space (foil) blanket
Splints (malleable, finger, hand, arm, inflatable, neck collar)
94 94
Medical kit
MEDICAL EQUIPMENT
Sterile gloves (disposable)
Sterile wipes
Suture kit and sutures
Tape (micropore)
Urethral catheter (syringes, lubricant, drainage bag)
Wound closure (adhesive strips, skin glue)
9595
Drugs
MEDICAL EQUIPMENT
CONDITION DRUG TYPE DRUG AND TREATMENT

SUGGESTIONS
Anaphylaxis adrenaline, Epipen (adrenaline),
steroids, prednisolone,
anti-histamine chlorpheniramine,
oxygen
Allergy anti-histamine chlorpheniramine

(Piriton),
diphenhydramine
(Benylin)
Asthma/ inhalers, salbutamol inhaler,

wheezing steroids prednisolone
Diarrhoea anti-diarrhoea, loperamide,

rehydration electrolyte drink,
Constipation laxatives ispagula husk,

fybogel, lactulose,
bisacodyl, senna
Dehydration rehydration rehydration powder

powder or or tablets
tablets
Eyes antibiotic, eye chloramphenicol eye

wash ointment 1%, sterile
saline
Indigestion antacid Rennie, Gaviscon,

omeprazole
Infection antibiotic amoxicillin,

(bacterial) flucloxacillin,
co-amoxiclav,
clarithromycin,
doxycycline,
metronidazole
96 96
Drugs
Pain analgesia paracetamol, codeine,
MEDICAL EQUIPMENT
aspirin, tramadol,
fentanyl, morphine
anti- ibuprofen, diclofenac

inflammatory
local lignocaine
anaesthetic
Personal diabetes, various, prescription

medication asthma, medications supplied
epilepsy, by crew member
heart disease,
lung disease,
hypertension,
allergies
Seasickness anti-emetic cyclizine, meclizine,

cinnarizine, hyoscine
(tablet or patch),
prochlorperazine
Skin creams, lotion calamine lotion,

hydrocortisone 1%
cream, co-trimoxazole
1% (canestan) cream
Sunburn creams, hat and shirt,

clothing sunblock, calamine
lotion
Bites and anti-histamines hydrocortisone

stings and steroid 1% cream, anti-
cream, insect histamines as above,
repellent DEET (50% minimum)
preparations
Wounds antiseptic sterile saline,

chlorhexidine
solution
Urinary lubricant for KY jelly

retention urinary catheter
9797
Index
INDEX
abdominal disorders 73–6 carbon monoxide

acid reflux 74 poisoning 89
constipation 73 chest compressions 16
diarrhoea 73–4 chest disorders 66–8
peritonitis 75–6 asthma 66
vomiting 74 infections 66
anaphylaxis 11, 63 pain 67–8
antibiotics 60–2 choking 22–3
anti-diabetic medication cold temperatures 3
65 compound fractures 33
antifungals 61–2 consciousness, loss of
asthma 66 24–5
constipation 73
Basic Life Support table CPR 19–20
19 crush injuries 28
bites and stings 81–4 cuts and lacerations 26
insects 81–2
sealife 82–3 dehydration 86
bleeding 29–31 diabetes 64–5
tourniquets, applying diarrhoea 73–4
30–1 dislocations 34
blisters 57–8 drowning 46–8
blood sugar levels 64 drugs see medication
broken bones see
fractures ears 52
burns 41–5 epilepsy 69–70
initial treatment 42–3 equipment, medical
later assessment 43–4 94–5
Rule of Nines 44 evacuation, medical
smoke inhalation 45 90–3
98 98
Index
INDEX
eye disorders 51 gynaecological disorders
eye injuries 49–50 79–80
fatigue 3 hand injuries 27–8

first aid kit 94–5 head injuries 39–40
fishhook injuries 27–8 heart attacks 67–8
food and drink 3, 41, 86 heartburn 74
foot injuries 27–8 heat exhaustion 85
fractures 32–8 heat stroke 85
ankles 37 hyperglycaemia 64
arm, upper 35 hypoglycaemia 64
clavicle 35 hypothermia 46
compound 33 infections 60–2
fingers 34 antibiotics 60–2
forearm 34 chest 66
jaws 37 urinary 77
legs 36 insect bites and stings
ribs 38 81–2
toes 34 insulin 65
wrist 34
frostbite 59 malaria 87–8
medication 8–11, 96–7
anaphylaxis 11, 63
antibiotics 60–2
anti-diabetic 65
antifungals 61–2
epilepsy 70
insulin 65
painkillers 9–10
seasickness 6
miscarriages 79
motion sickness see
seasickness
9999
Index
INDEX
noses 53–4 sea blindness 51

seasickness 4–7
penicillin allergy 61 crew with 7
peritonitis 75–6 medication 6
planning 1–2 prevention 5
poisoning 89
pregnancy, ectopic 80 skin 56–9
blisters 57–8
recovery position 21 eczema 57
rescue breathing 17–18 frostbite 59
resuscitation 12–25 impetigo 57
airways 13–14 rashes 56
Basic Life Support table shingles 57
19 sunburn 56
breathing 14 smoke inhalation 45
chest compressions 16 strokes 71–2
choking 22–3 sunburn 56
circulation 15
CPR 19–20 teeth 55
recovery position 21 tourniquets, applying
rescue breathing 17–18 30–1
unconscious crew 24–5 tropical diseases 87–8
urinary disorders 77–8
vomiting 74
100
100
101
OTHER BOOKS IN THE SERIES
OTHER BOOKS
REEDS SKIPPER’S
HANDBOOK
Andy Du Port and
Malcolm Pearson
Completely revised
8th edition
ISBN: 978-1-3994-1429-6
REEDS WEATHER
HANDBOOK
Frank Singleton
2nd edition
ISBN: 978-1-4729-6506-6
102102
Other books in the series
OTHER BOOKS
REEDS CLOUD
HANDBOOK
Oliver Perkins
ISBN: 978-1-4729-8207-0
REEDS KNOT
HANDBOOK
ISBN: 978-1-4729-7910-0
103
103
Other books in the series
OTHER BOOKS
REEDS 9-LANGUAGE
HANDBOOK
ISBN: 978-1-4729-8494-4
REEDS MARITIME
FLAG HANDBOOK
Miranda Delmar-Morgan
3rd edition
ISBN: 978-1-4729-9445-5
104104

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BLOOMSBURY and REEDS are trademarks of Bloomsbury Publishing Plc

This electronic edition published in 2024 by Bloomsbury Publishing Plc

Copyright © Martin Thomas and Olivia Davies, 2024

Illustrations by Richard Thomson @ rt-imagery.com

All rights reserved. No part of this publication may be reproduced or

ISBN: PB: 978-1-3994-0121-0;

Typeset in Myriad Light 9/11pt by carrdesignstudio.com

Although there is a limit on what can be done on a

Examples are MSOS (Medical Support Offshore) run by

Dr Spike Briggs, PRAXES (Clipper Telemed) and Medaire.

Prevention is better than cure

COLD AND FATIGUE

Every seafarer has been afflicted by seasickness at some

 Set out on the voyage rested, well hydrated and alcohol

Medication designed to prevent seasickness should be

Codeine is a mild opioid and a stronger analgesic, which

Tramadol is an effective prescription-only opioid and

Mild pain Non-opioid analgesics

 Paracetamol 1g, 4 times a day

Moderate Mild opioid analgesics

Severe pain Strong opioid analgesics (stop weaker

If the patient cannot keep down the medication, perhaps

should be started on any person who is unresponsive

Move the patient to a place in the boat where resuscitation

2 Place one hand on the forehead, applying pressure to

3 Place fingers of the other hand under the chin and

If there is a suspicion of traumatic cervical spine injury,

keep the head and neck as still as possible using manual

4 Remove any foreign bodies that might obstruct

Take up to 10 seconds to check for breathing. Look for chest

If the patient is breathing then place in the recovery

1 To perform chest compressions effectively, lay the

3 With the arms locked straight compress the chest by

1 Kneel next to the patient’s head.

2 Be sure to maintain the open airway by tilting the head

3 Pinch the nostrils closed, take a breath, seal your lips

4 Observe chest expansion then break the seal by

If you are unable or unwilling to give rescue

breaths, give continuous chest compressions. Properly

AT A GLANCE – Basic Life Support

 Call for help

CPR can be exhausting and is best done by two or more

Minimise any interruptions to CPR and do not waste time

longer. CPR should be prolonged in cases of hypothermia,

drowning, electrocution and in children, when you should

Early evacuation. Patients who recover following CPR

1 Kneel beside the patient.

2 Bend the arm closest to you at a right angle with palm

6 Tilt the head back to maintain an open airway. Check

What to do about choking

Unconscious Conscious Encourage cough

Start CPR 5 back blows Continue

A foreign body can obstruct the airway and cause choking.

2 If these back blows fail to relieve the obstruction then

3 Stand behind the patient and put both arms around

4 Place one clenched fist in the upper abdomen below

A crew member may collapse and become unconscious

Causes of decreased consciousness

Syncope Fainting due to:

Paracetamol 1g, 4 times a day

Illness Diabetes (low or high blood sugar)

Poisoning Carbon monoxide

Early evacuation. A patient suffering major haemor