Tony Pozun is New York State Registered Professional Nurse, American Heart Association registered CPR first aid instructor and a retired Nassau County Police Officer/Detective Sergeant with 35 years of service. Tony is also an avid long distance sailor and a regular contributor to Cruisers Net. Thank you Tony!

Medical Emergencies at Sea
Anthony Pozun, B.S., R.N.

I am a retired Detective Sergeant, from the Nassau County Police Department, having served thirty-five years. Twenty of those years were as a patrol officer responding to hundreds of calls for medical emergencies. I was a Certified First Responder, and Emergency Medical Technician (EMT). While assigned to the Police academy I was a master instructor of basic and advanced first aid, EMT and mental health training. I currently have a NYS license in professional Nursing (RN). I am a current member of the Northport Yacht Club, Northport NY, where I am on the training committee. I also teach Basic Boating and Sailing courses for the Neptune Sail and Power Squadron (United States Power Squadrons) in Northport. I have been a boater and sailor for some fifty years. I currently sail and cruise with my wife on our Catalina C 400 Mystical Paradise.

Now that the boating season is ending, it may be worthwhile to think about vital information for next season. Many of us who boat love its sense of adventure, enjoyment and freedom. When we go out on our vessels though we leave the safety and convenience of our home and face many different challenges. One of the most challenging is medical emergencies at sea. Whether we boat close to home in a bay, sound, coastal or long distances, the time speed and distances involved, limits our ability in seeking and receiving outside medical help in an emergency. Whereas on land we may get help in a matter of minutes, on the water it may be indeed many minutes or hours before receiving professional help. To an extent we must learn to become self-sufficient. This includes having some basic knowledge of first aid.

Modern medicine has had amazing medical advances throughout the years. It is equally amazing though how little has changed about emergency medical
care away from home. This article is not meant to recommend specific recommendations regarding medical aid at sea, but give a practical approach in obtaining enough knowledge of emergency care, and keeping some useful equipment on board for use during an emergency

For this article I will address two categories of how most of us boat.

1. Local boating where nearby friends, crew can render aid, or summons help quickly. And professionals may render aid in timely manner.
2. Coastal cruising away from home perhaps hours away from help.

Within these two categories you will be able to communicate with medical personnel, and or deliver a sick or injured to an emergency room within hours. Most common on-board emergencies though will be treatable without outside assistance at least initially and limit further injury. To do these onboard treatments, you need a reference of medical knowledge, either yourself or a reference (book), and some basic medical equipment. Most of us may not have the necessary knowledge or the stamina to treat without some help and the following medical emergency references would be of value. Note any reference guide to be of any value should be read thoroughly before a situation happens. This is not a comprehensive list as there are hundreds of worthy publications available to those who do some research.

Advanced First aid American Red Cross
First Aid Afloat, by Doctors Eastman/ Levinson; ////
Pocket Emergency Medicine, by Hamdani;
First Aid Afloat by Robin Horworth;
On Board Medical Emergency Handbook by Briggs / Mackenzie;
First Aid Companion by, Hillincourt;
.
If you are unprepared for the emergency despite your knowledge and references available, your VHF and or cell phones should enable you to gain access to shore side medical advice. The local Police, Fire Departments, and or the Coast Guard may offer advice and or be able to put you in touch with doctors and other medical professionals.

Once you have made an informed decision that your knowledge, references and your ability are adequate to treat the current situation, you would probably need some medical supplies say as those in a good on-board medical kit. Many retailers, boating supply houses, specialty adventure type stores, even medical supply houses themselves offer
good quality (often expensive) medical kits. But all kits may not be specific to your usage and needs. With a bit of planning and research you can put together a kit specific to your needs and use. Your kit can be put in an ordinary plastic (doesn’t rust) tool or fishing tackle box, the size and type of which is according to your amount of supplies. Listed below are some necessary supplies. Some items must be prescribed by a doctor.

Medical Condition Item

Lacerations Iodine, Beta dyne
Alcohol preps
4 x 4 in gauze
Steristrips (stitching)
Assorted band aids
2in and 4in cotton rolls
½ in bandage tape
Triple Antibiotic ointment
Bactroban ointment
One pair sharp pint scissors
Tweezers, Forceps

Sea Sickness Meclizine, Transderm Scop patch Bonine, Dramamine
Wrist bands
Ginger tablets, coke syrup

Allergic Reactions Epi Pen (epinephrine.)
Epinephrine Bottle
Oral Benadryl 25mg tabs
Claritin tabs

Infection Augmentin 500 mg tabs
Doxycycline 100mg tabs v
Neosporin ointment
Neosporin ear suspension
Cipro 500mg tabs

Asthma attack Pro air albuterol inhaler
Prednisone

Cough Delsuym or another OTC medicine
Menthol cough drops

Anti-inflammatory/Pain Advil/Motrin/ ibuprofen
Aleve

Fever Tylenol extra strength tabs

Nasal congestion Afrin spray
Sudafed tabs

Minor burns, abrasions Bactine, Lanaicaine spray

Stings, bites Hydrocortisone ointment
Calamine Lotion
Ambesol

Gastric/Diarrhea Pepsid, Mylanta, Tums
Imodium, Charcoal tabs

Fractures/contusions Triangular bandage
Various splints/ splint bandage
Assorted ace bandage

Cardiac chest pain Aspirin 325 mgs

Cardiac patient /potential Ambu bag (forced air inflator)
Mouth air mask
Defibrillator

Some basic first aid, certainly not everything.

1. Attend to severe bleeding first. Remember DEPT: use clean gauze apply Direct pressure to wound; Elevate wound above the heart; apply Pressure to pressure points (brachial inside of bicep, femoral inside of thigh); apply Tourniquet just above wound***used only as a last resort, when if bleeding continues, person will die

2. Cardiac arrest /cessation of breathing/ call for immediate help, remember CAB

C Circulation, lack of heartbeat perform chest compressions
A Airway, clear airway of obstruction person on back /chin lift
B Breathing, listen and look chest movement if none start mouth to mouth

3.Wounds with impaled objects or imbedded glass/ do not remove object, cover with clean gauze, wrap loosely, do not apply any heavy ointment/crème. Clean wounds/ close wounds if possible, wrap to stop bleeding, keep immobilized, and keep out dirt.
4. Eye wounds/ protect eye keep out sun cover with gauze patch, do not cause pressure.
5. Bruises Contusions sprains/ apply ice immediately, ace bandage to immobilize, put no pressure on joint limb etc., and limit movement
6. Fractures/ Dislocations/ immobilize limb/ splint limb in place as found (never reset bone/ limb) use gauze cover to stop any bleed.
7. Burns/ if slight soak in cold water. Skin broken cover same with gauze (air hurts) do not apply ointment or cream, treat for shock (elevate feet)
8. Fainting spells/ have person lie down elevate feet. Monitor /watch breathing.
9. Heat poisoning and heat stroke/ remove from sun/heat, cool off slowly, give water sparingly
10. Ingested poisons substances/ give copious amounts of water; induce vomiting only if ingested substances are nonacid (may burn on way out).
11. Stings bites imbedded small objects spines/ clean area remove stinger or hook apply antibiotic/Ambesol, cover with clean gauze /band aid

In closing, boating can be great fun and freedom, but with that fun and freedom comes responsibility. Look into buying an emergency medical reference(s) to keep on board. Local book stores, Amazon and many online sites can get you what you will need. If you don’t have a first aid kit, buy or prepare one for the sake of yourself, your loved ones and crew on the boat. If you have never taken a first aid course or it’s been awhile since you took one, contact your local American Red Cross or local Fire Department and attend a basic first aid course. With a little preparation research and work on your part most emergencies at sea (wherever that is for you), can be handled without loss of life or limb. Happy and safe boating.
Anthony Pozun

Tony Pozun is New York State Registered Professional Nurse, American Heart Association registered CPR first aid instructor and a retired Nassau County Police Officer/Detective Sergeant with 35 years of service. Tony is also an avid long distance sailor and a regular contributor to Cruisers Net. Thank you Tony!

Sailing Injuries
By Anthony Pozun, BS, RN.

Anthony Pozun is a New York State registered professional nurse and former Detective Sgt., EMT, first aid basic and advanced courses instructor at the Nassau County police Academy. He is a current member and certified instructor for the United States power squadrons for sail and basic boating courses of instruction. He has been an avid boater and sailor for 50 years. He has sailed intensively on Long Island sound with his wife Barbara for the past 30 years. He has traveled and sailed the East Coast including the Intracoastal Waterway from Northport to Florida and the Bahamas and back again. He currently sails a Catalina C 400 Mystical Paradise, sailboat set up for long-term cruising. He has written many sails and first aid, articles, which have been published in many local and national boating periodicals.

Sailing as a pastime, hobby or a full-time leisure activity, can be both fulfilling and enjoyable. A sailboat has many working parts necessary to convert wind into propulsion to use the sailboat. These many working parts need to be respected, and preplanning is essential in their usage. The many working parts and movement of these parts and the sailboat itself, can cause accidents, falls, collisions, which may lead to injury sometimes severe. But with a little bit of planning and forethought, before its usages, the sailboat and its many working parts, can be enjoyed without injury.

This article will discuss the possible incidents and accidents, leading to injuries, and will give some suggestions for preplanning, prevention, commonsense rules, on dealing with the many working parts of a sailboat to prevent injuries. Additionally, at the end a basic primer on basic first aid including some of these of injuries will be discussed. These incidents include falling overboard, falling down hatches, falling, tripping on working lines and devices around the deck or cockpit. Hand and finger injuries as well as swinging boom injuries will be discussed. Running aground or hitting fixed objects will also be covered. Cooking aboard injuries, maintenance injuries, and seasickness although not a true injury, will be discussed. One overriding principle to be used to prevent accidents occurring, is to preplan in one owns mind what needs to be accomplished, how to do it, what can go wrong, how injury can be prevented.

Being swept overboard is one of the most fatal type injuries that can occur on a sailboat. But most overboard incidents can be avoided with the application of certain precepts. These include using a little common sense, some preplanning caution and a thorough examination and assessment of one’s environment and surroundings. Put together this is all called prevention. The main thought of any person should be “stay on the boat”,” stay on the boat”,” stay on the boat”. Asking oneself to do I need to work on deck, what pitfalls are present, i.e. low or no lifelines, low freeboard, open transom, etc., that could lead to going overboard. All crew members working on the sailboat should at least wear a PFD, personal flotation device. A member alone on deck, at the helm, or a lone sailor, should always wear a PFD, with a safety harness and tether attached to the boat, because no one will see him or her being swept overboard. Mentally crewmembers or guests should obey the adage when moving about; “one hand for me, one hand for the boat”. They should move about low to the deck, slowly and purposely always keeping one hand attached to the boat. Because we cannot always prevent persons going overboard, certain safety equipment should be available on the sailboat. This may include main overboard poles, life rings, throw rings, floatable, cushions. A hoist, PFD’s with GPS locators, all items to assist retrieval of persons thrown overboard. Secondly , Captains and their crew should practice man overboard drills to see how it’s done, to deal with any issues that arise, so in a real incident they know what to do.
Another serious incident is falling through open hatches and walkways. This can result in injuries ranging from contusions to serious fractures. Again, a little prevention through preplanning will help. The adage “one hand for me one hand the boat “must be observed. When moving about a moving or stationary boat one must move cautiously, slowly, and with purpose. Rushing about only causes injuries. Crew members or guests before sailing should study the locations of hatches, companion ways, and other openings which could cause a fall. Think before you move, move slowly, should be your mental condition. Owners of boats may mark those areas of danger with protective foam, and or highlight with bright colors or decals to warn others.
A third incident that may occur is tripping and falling on deck and cockpit lines and many devices used during sailing. These injuries include bruises, contusions and fractures to toes, feet, lower limbs and upper limbs from tripping and falling. Preplanning and Prevention is the key to prevent these injuries. First, study your environment, know what can trap or trip you i.e. lines, cleats, blocks, winches, and many other devices which may bite. Always move slowly purposely keeping one hand for you one hand for the boat as your mantra. Always wear sturdy shoes, boat shoes or sneakers. Never move about the boat with sandals, Flip-flops, other loose footwear or barefoot. Think before you move, ask yourself is this necessary, and what can happen to me.
A fourth type of incident which can lead to serious consequences is swinging boom accidents. The boom on a sailboat is constantly moving, is heavy and has a tremendous amount of force behind it. Injuries are many and include concussions to the head, injuries to the body and even being swept overboard. Crewmembers and passengers should always assess the possibility of being struck by the boom. Some prevention includes, not moving about, not standing up completely, and watching for accidental jibes or tacks which may cause accidental movement of the boom. Crew and guests should always listen to commands of the captain, during tacks and jibes, and only move about if it is necessary as part of their job. Before moving, think of what the task is, stay low, move slowly and purposely, again keeping the adage “one hand for me one for the boat.”
Another incident which can cause serious injury is hitting another object, boat, fixed dock etc. or sandbar, which causes immediate stoppage of the boat. In these situations, persons may be thrown about. Injuries occurring from this include contusions, abrasions, fractures, concussions and many worse. Preplanning and prevention is the key to preventing these types of injuries. Always know where your boat is, what are my depths, where are the hazards I may encounter. Common sense and preplanning must always be used to control the direction and motion of the boat. Captains and crew must constantly be observant for these hazards and prepare to avoid them. Use of charts, maps, radar or sonar if available, previous knowledge or information should be diligently applied. If there is ever a question or unknown information which causes a dangerous condition, captain or crew should immediately slow or stop the boat, reassesses the situation and if necessary contact, via radio persons that know the area and may help. The Coast Guard, Tow Boat US, Sea Tow, Harbormasters, or even local commercial fisherman are persons with a wealth of information about local areas unfamiliar to the boater. The avoiding of any object should be the focus of a crewmember or the captain.
Cooking on a boat is not like cooking at home on a steady platform. Because of movement of boat, hot water, steam, flames, may move, surfaces may move, items may shift resulting in burns, cuts from knives, or appliances, injuries to body from movement. Preplanning and prevention may help: know your environment; are there possible splashes of hot fluids, loose items, sharp edges, that will hurt me. Cruising crew should always think of what they are going to do, secure loose items, obtain necessary tools before they start. Always know the limits and capacities of cooking systems, danger or flame, spillage possibilities and other things that may injure. They should always know the location of emergency gas shutoff switches, fire extinguishers, and procedures of what to do in case of fire. Again, they should move slowly purposely and obey the adage one hand for me one hand for the boat. If cooking underway, person in galley should use available handholds and or be tied in to secure locations to prevent falls.
Seasickness although not a true injury, is an illness that can cause much dismay pain and discomfort as to ruin the crewmembers or guest day and/or trip. Often called motion sickness, mal de mar, “I want to die syndrome”, and many other terms, it can be a wrenching illness. It is caused by one’s brain and central nervous system receiving conflicting signals from the inner ear and the eyes. It can occur out on the ocean or on a calm day in a bay with devastating results. The symptoms may include: dizziness; nausea; vomiting; painful stomach; balance problems; feeling of movement when there is none. Prevention before the onset of seasickness is perhaps the only cure. Medically there are medications and devices which may be taken including, Bonine Meclizine, Benadryl and others. Accu bands which create pressure on key pressure points on the wrist, have been known to prevent seasickness also. Avoiding heavy greasy meals before or during sailing, avoiding caffeine drinks, and avoiding those foods which is known in the past to cause sickness will help. While on board sit in the middle of the boat, keep your eyes open on the water and boat, keep busy if possible, hydrate with water, ginger ale, cola syrup, eat ginger cookies, saltines etc. Do not go below. Sometimes sleep can cure the illness. Often the only cure may be to get oneself on dry land. In any event prevention before the onset seems to be the most diligent cure.
Because a sailboat as many working systems, maintenance is necessary. Performing maintenance can cause a myriad of injuries if not thought out ahead of time. First know your limitations is this a job I can do for myself or left to professionals. Know your equipment engine parts and other moving parts i.e. blocks, lines, winches, electrical, booms. Moving or standing rigging can catch or hit body parts, causing simple to massive injuries. If there be a choice of working on Dynamic versus Stagnant machinery systems, working on stagnant, non-moving or non-charged systems is always preferred: Hands or other body parts may get caught in a moving engine; The charged Electrical system may cause serious burns; Rigging under load (which has tremendous release force capabilities) will cause serious injuries. Preplanning safety includes making sure these systems are all shut down and not under load. Plan move slowly and purposely. Have all tools available/ think before acting. Use extreme caution if it is necessary to work on Dynamic, moving or charged systems, i.e. engine adjustments, electrical adjustments, rigging and sailing repairs. When working on boat on dry land be sure ladders are safe and secured to the boat. Be particularly slow and cautious on ladders, move slowly and cautiously as falls from heights to the ground may be catastrophic.

Some basic first aid, certainly not everything.

1. Attend to severe bleeding first. Remember DEPT use clean gauze, apply Direct pressure to wound; Elevate wound above the heart; apply Pressure to pressure points (brachial inside of bicep, femoral inside of thigh); apply Tourniquet just above wound***used only as a last resort., when if bleeding continues, person will die immediately.
2. Cardiac arrest /cessation of breathing/ call for immediate help, remember CAB
C Circulation, lack of heartbeat- perform chest compressions
A Airway, clear airway of obstruction person on back /chin lift
B Breathing, listen and look chest movement if none- start mouth to mouth

3. Wounds with impaled objects or imbedded glass/ do not remove object, cover with clean gauze, wrap loosely, do not apply any heavy ointment/crème. Clean wounds/ close wounds if possible, wrap to stop bleeding, keep immobilized, and keep out dirt.
4. Eye wounds/ protect eye keep out sun cover with gauze patch, do not cause pressure.
5. Bruises Contusions sprains/ apply ice immediately, ace bandage to immobilize, put no pressure on joint limb etc., and limit movement
6. Fractures/ Dislocations/ immobilize limb/ splint limb in place as found (never reset bone/ limb) use gauze cover to stop any bleed.
7. Burns/ if slight soak in cold water. Skin broken cover same with gauze (air hurts) do not apply ointment or cream, treat for shock (elevate feet)
8. Fainting spells/ have person lie down elevate feet. Monitor /watch breathing.
9. Heat poisoning and heat stroke/ remove from sun/heat, cool off slowly, give water sparingly
10. Ingested poisons substances/ give copious amounts of water; induce vomiting only if ingested substances are non-acid (may burn on way out).
11. Stings bites imbedded small objects spines/ clean area remove stinger or hook apply antibiotic/Ambesol, cover with clean gauze /band aid.
13. Water Hypothermia- remove person from water immediately. Remove wet clothing cover with space blanket or dry blanket. Re heat body slowly warm (not hot wrapping), warm liquids Monitor vitals, TX for shock.
14. Shock- from loss of blood to brain/ other trauma–. Have person lie down elevate feet monitor all vitals watch especially for breathing. Give o 2 as needed.
15. Head injuries concussions –treat open wounds as above. Have person lie down, check and monitor vitals, closely continue to monitor breathing and vitals. Get immediate help.

Whether it be day sailing in the bay or cruising on the coast, sailing is an adventure. But it is a working adventure with an environment of many moving parts and systems. These working dynamic systems must be worked with and respected. The sailor must constantly assess and reassess his surroundings and actions to those surroundings, for to ignore them may lead to serious injury and more. Boat and crew preparation as well as planning is essential. Sailing can be rewarding and absent of accidents and incidents. Where sailors prepare their boat with regards to safety, have a plan, know and using known safe techniques, use non-sense approaches, analyze tasks and move slowly, they will insure a safe and happy voyage. This is true for the big ocean sailor, as well as the small day sailor.

Fair winds and happy sailing to all…author