Practical guidance for common offshore medical situations. This guide covers the situations you are most likely to encounter. It does not replace proper first-aid training — take a course if you haven't. The skipper carries a full first aid kit and has basic medical training.
Important: In any serious or life-threatening medical emergency, declare Pan Pan or Mayday on VHF Channel 16 and request medical assistance. Many coast guards have medical officers available. Your position (GPS coordinates) is the most critical piece of information you can give them.
Medical Kit Contents
The skipper's kit is an orange Pelican case at the nav station. A well-stocked offshore kit for a 6–8 person crew on a week-long Mediterranean trip should contain:
- Disposable nitrile gloves ×20 pairs
- Sterile gauze pads, assorted sizes
- Rolled bandages ×6; triangular bandage / sling ×2
- Steri-strips / wound closures ×20; adhesive plasters, assorted
- Israeli pressure bandage ×2
- SAM (flexible) splint ×1
- Bandage scissors / trauma shears; fine-point tweezers; thermometer; penlight; CPR face shield
- Saline eye wash ×2 vials; antiseptic (chlorhexidine) wipes ×20; Betadine (povidone iodine) 100 ml
- Antibiotic ointment (e.g. Fucidin); hydrocortisone cream 1%; aloe vera gel; vinegar (small bottle, for jellyfish)
- Paracetamol ×40; ibuprofen ×30; oral antihistamine (cetirizine) ×20; antihistamine cream
- Cinnarizine (Stugeron) ×30; scopolamine patches ×6
- Oral rehydration sachets ×10; antidiarrhoeal (loperamide) ×20; antacids ×20
- Broad-spectrum antibiotic (by prescription); EpiPen / adrenaline auto-injector if available
- Burn gel dressings ×2; oral glucose gel ×2
1. Seasickness — usually manageable
Motion sickness from conflicting signals between the vestibular system and visual input. Very common even in experienced sailors. Almost always resolves as the body adapts.
Prevention
- Cinnarizine (Stugeron) 25 mg: 2 tablets the evening before sailing, then 1 every 8 hours. Start early — it takes 2+ hours to reach therapeutic levels.
- Scopolamine patch: behind the ear 4–6 hours before sailing; lasts 72 hours. Side effects: dry mouth, blurred vision.
- Avoid heavy/greasy/spicy food and alcohol the night before; sleep well.
Treatment
- Stay on deck, in the cockpit. Going below makes it dramatically worse.
- Fix your gaze on the horizon. Sit or recline amidships (it moves least).
- Sip water regularly; dry crackers, ginger biscuits or ginger chews can help.
- Avoid reading, screens, or looking at charts.
- If you vomit, lean over the leeward side, rinse your mouth, rest.
Recovery position: if very unwell, lie on their side in the cockpit. Never leave a seasick person unsupervised below deck — risk of aspiration if vomiting while alone. Evacuate if they cannot keep any fluids down for more than 6 hours, show confusion or extreme distress, or cannot function safely on a watch.
2. Sunstroke / Heat Exhaustion — heat exhaustion: manageable · heat stroke: emergency
These are two distinct conditions; knowing the difference determines the urgency.
| Feature | Heat exhaustion | Heat stroke | | --- | --- | --- | | Skin | Cool, pale, clammy (sweating) | Hot, dry, flushed (sweating stops) | | Temperature | Normal or slightly raised | Above 40°C / 104°F | | Consciousness | Alert but weak, dizzy, nauseous | Confused, agitated, may lose consciousness | | Heart rate | Fast, weak pulse | Fast, strong pulse | | Urgency | Urgent — treat now | Medical emergency |
Heat exhaustion: move to shade with air movement; lay them down, raise legs slightly; remove excess clothing; cool with a wet cloth on forehead, neck, armpits, wrists, and fan them; give cool (not ice-cold) water or oral rehydration salts to sip; should improve within 30 minutes.
Heat stroke (emergency): aggressive, immediate cooling — get them into shade; immerse in cool (not icy) seawater if safe, or pour seawater over the whole body; wet sheets and fan continuously; ice packs to armpits, groin and neck; do not give fluids if unconscious or confused (aspiration risk); transmit Pan Pan and get medical advice — heat stroke can be fatal.
3. Dehydration — common, easily prevented
Hot sun, wind, activity and sea spray all increase fluid loss; many confuse dehydration with seasickness. Monitor with urine colour — pale yellow is good, dark amber means drink now.
- Mild: thirst, dry mouth, darker urine, slight headache.
- Moderate: headache, fatigue, dizziness on standing, dry skin, muscle cramps.
- Severe: rapid heartbeat and breathing, sunken eyes, no urination for 8+ hours, confusion — medical emergency.
Treatment: sip water steadily (150–200 ml every 15 minutes — don't chug); oral rehydration salts replace electrolytes and are far better than plain water for moderate dehydration; move to shade and rest; avoid alcohol. Evacuate if confused, unable to keep fluids down, showing severe signs, or not urinating in 8+ hours despite drinking.
4. Cuts & Lacerations — minor: aboard · severe: evacuate
Saltwater wounds are at high risk of infection. A minor cut can become serious on a boat if not treated properly.
Cleaning: gloves on first; stop bleeding with direct pressure on a clean gauze pad for 5–10 minutes without releasing; once controlled, irrigate thoroughly with clean fresh water or saline (forceful irrigation with a syringe removes debris best); apply Betadine around — not deep into — the wound, diluted to a light-tea colour; do not put neat alcohol in a deep wound.
Closure: steri-strips (butterfly closures) for gaping wounds not needing stitches — dry the skin, apply strips perpendicular to the wound, cover with a non-stick dressing. Needs stitches: any wound over 1 cm that won't hold closed, deep wounds, hand/face wounds, jagged or rolled edges — these need medical attention. Change dressings daily or whenever wet/dirty.
Signs of infection (check daily): increasing redness, warmth and swelling after the first 24 hours; yellow/green pus; red streaks from the wound edge (spreading infection — serious); fever or feeling unwell. Seek medical attention for wounds needing stitches, any infection, puncture wounds, wounds near joints/tendons, animal bites, or wounds not improving after 48 hours.
5. Sea Urchin Spines — usually manageable aboard
Common in rocky Mediterranean areas. Spines are brittle, barbed and can break off inside the skin. The real risk is infection and granuloma from retained spines.
- Do not squeeze or pull spines with your fingers — they are barbed and will break off deeper.
- Soak in warm water with vinegar for 15–30 minutes to soften the spines.
- With sterile fine-point tweezers, grip a visible spine close to the skin and draw it straight out the way it entered.
- Clean with Betadine, apply antibiotic ointment, cover with a clean dressing.
- Check daily for infection.
Deeply embedded spines that break: do not dig for them — they often work out naturally over 1–2 weeks. Seek medical attention at the next port. Ibuprofen helps pain and inflammation.
6. Jellyfish Stings — usually manageable · severe reaction: emergency
Mediterranean stings are usually unpleasant but not dangerous (the common culprit is Pelagia noctiluca, the mauve stinger). Rarely, severe allergic reactions occur.
- Rinse with seawater — NOT fresh water (fresh water makes unfired nematocysts discharge).
- Do not rub the area.
- Remove visible tentacles with tweezers, a credit-card edge, or gloved fingers — never bare hands.
- Apply vinegar to neutralise remaining nematocysts (or a baking-soda + seawater paste).
- Hydrocortisone or antihistamine cream for inflammation and itch.
- Oral antihistamine (cetirizine); ibuprofen or paracetamol for pain.
Anaphylaxis is a medical emergency: difficulty breathing, throat swelling, widespread hives, pale/clammy skin, rapid weak pulse, collapse. If an EpiPen is available, use it immediately in the outer thigh, transmit Mayday, and get to shore.
7. Sunburn — manageable aboard
Worse at sea — UV reflects off the water (up to 25% more exposure) and the breeze masks the burning. Prevention (SPF 50+ every 2 hours, reapplied after swimming) is vastly easier than treatment.
- Cool the burn with cool (not icy) water or a wet cloth for 10–15 minutes, repeated.
- Apply aloe vera gel generously and frequently; hydrocortisone cream 1% two to three times daily.
- Ibuprofen for pain and inflammation; increase fluid intake.
- Cover the burned area for the rest of the trip — re-exposure dramatically worsens the damage.
- Do not pop blisters; if blisters form, the burn is severe — keep covered and seek advice.
8. Hypothermia — always take seriously
Core temperature below 35°C (95°F). Even in summer, cool water (often 18–24°C) can cause hypothermia after extended immersion; wet, windy night sailing is also a risk without immersion.
| Stage | Core temp | Signs | | --- | --- | --- | | Mild | 32–35°C | Vigorous shivering, impaired coordination, slurred speech, pale cold skin | | Moderate | 28–32°C | Shivering stops (very bad sign), confusion, stumbling, slow pulse | | Severe | <28°C | Unconscious / minimally responsive, no shivering, very slow or absent pulse |
Treatment (mild–moderate): get them out of wind, water and cold; remove all wet clothing; passive rewarming first — wrap in dry blankets/sleeping bags from all sides, cover the head, use body-to-body contact in a sleeping bag; warm the space; if conscious and able to swallow, warm (not hot) sweet drinks — never alcohol; warm packs to armpits, groin and neck; monitor responsiveness every few minutes.
Do NOT: rub the limbs vigorously (drives cold blood to the core, can stop the heart); give alcohol; use a hot bath (rapid rewarming can cause fibrillation); let them stand or walk unassisted.
Evacuate any moderate/severe hypothermia, any shivering that stops without improvement, any loss of consciousness. "No one is dead until they're warm and dead" — continue CPR and seek evacuation.
9. Fractures & Sprains — usually manageable, may need evacuation
Most often from falls on deck, slips in the companionway, or being thrown against fittings. The foot and ankle are the most common sites.
RICE for sprains: Rest (keep weight off); Ice (wrapped in cloth, 15–20 min on/off — never directly on skin); Compression (firm, not too tight — check circulation below every 30 min); Elevation above heart level.
Suspected fracture — improvised splinting: check circulation, sensation and movement below the injury (if absent, emergency); do not straighten an angulated fracture (splint as-is) unless circulation is absent; splint the joint above and below with the SAM splint or an improvised rigid object padded with clothing; bandage firmly and re-check circulation; elevate; ibuprofen + paracetamol together for pain. Evacuate for suspected femur, pelvis, spine or skull fracture; any fracture with absent circulation/sensation; open (compound) fractures; rib fractures causing breathing difficulty.
10. Head Injury — always take seriously
Most often from an unexpected gybe (the boom strikes someone), a fall below, or a collision. Even a "mild" blow must be taken seriously.
Warning signs — never ignore (seek evacuation): loss of consciousness (even briefly), confusion or disorientation, repeated vomiting, a severe and worsening headache, unequal pupils, limb weakness or numbness, difficulty speaking, seizure, clear fluid from nose or ears, or inability to remember the incident.
Concussion: mild concussion is brief confusion, headache, dizziness, "fogginess", mild nausea with no loss of consciousness. The worsening rule: if any symptom is getting worse over time, this suggests possible intracranial bleeding — an emergency. Rest completely (no reading, screens or concentration). Never leave a head-injured person alone for the first 12 hours — wake them every 2 hours at night and check they respond normally and know their name. Paracetamol for headache; avoid ibuprofen and aspirin (bleeding risk).
11. Choking — emergency, act immediately
A choking person cannot breathe or speak and may clutch their throat and turn blue. You have ~3–4 minutes before brain damage begins.
Heimlich manoeuvre (adults)
- Stand behind them. Ask "Are you choking?" — if they can't speak or are turning blue, act immediately.
- Lean them forward; give 5 sharp back blows between the shoulder blades with the heel of your hand.
- If not dislodged, place both arms around their waist from behind.
- Make a fist, thumb-side in, just above the navel and well below the breastbone.
- Grab your fist with the other hand; give 5 sharp inward-and-upward thrusts.
- Alternate 5 back blows and 5 abdominal thrusts until the object clears or they lose consciousness.
- If they lose consciousness, lay them down and start CPR; check the mouth before rescue breaths and remove any visible obstruction (no blind finger sweeps).
For pregnant or obese individuals, place the fist higher — on the centre of the chest.
12. CPR — Cardiopulmonary Resuscitation
Core ratio: 30 chest compressions : 2 rescue breaths. Repeat without stopping.
- Check for response: tap shoulders, shout. No response? Shout for help.
- Check breathing: tilt the head back, lift the chin, look/listen/feel for no more than 10 seconds. Gasping or no breathing = start CPR.
- Call for help — transmit Mayday, get coast guard on Ch16. Delegate this; don't leave the person.
- Compressions: heel of one hand on the centre of the chest (lower half of breastbone), other hand on top, fingers interlaced, arms straight. Compress 5–6 cm deep at 100–120 per minute. Push hard, push fast, let the chest fully recoil.
- After 30 compressions: tilt head, lift chin, pinch the nose, seal your lips around theirs, give 2 breaths (1 second each, enough to see the chest rise). Resume compressions immediately.
- Continue without stopping. Switch compressors every 2 minutes if possible.
- If an AED is available: apply it as soon as possible without interrupting compressions; follow the voice prompts.
When to stop: the person shows clear signs of life; a more qualified person takes over; you are physically unable to continue and no one else can; or a doctor pronounces death. Do not stop CPR on your own judgement at sea.
Emergency numbers (Greek waters example): Police — 100; Port Police / Coastguard — 108; First Aid / Ambulance (EKAV) — 166; EU Emergency (all services) — 112; VHF distress — Channel 16. Save the equivalents for your sailing area before departure. In any life-threatening emergency at sea, VHF Channel 16 reaches the coast guard faster than a mobile call.