While updating our first aid skills we have been lucky enough to spend time with two doctors who both sail and, in addition, have a lot of emergency room trauma experience. They confirmed one of the items Blair, our wilderness first aid instructor, taught us, which is that there are at least three things you really don’t want to do to yourself in a remote location:
- Break your femur because it is likely you will bleed to death.
- Get a bad head injury because it is likely that your brain will swell and you will die.
- Have a cardiac arrest because, contrary to what the TV and movies would have you believe, CPR with or without the presence of a defibrillator, very rarely works.
And here’s the really disturbing thing. Even if you have the best orthopaedic, or brain or heart surgeon in the world aboard, it will make very little difference to whether or not you survive the above injuries because without a fully equipped hospital there is not a lot that even the best professionals can do for you, never mind an amateur with a bit of first aid training.
Comes as kind of a jolt doesn’t it? Particularly since we have all been conditioned to think that if we just have a lot of expensive drugs, a great first aid kit and some really good first aid training we will be safe.
So I’m thinking that the most important piece of medical gear on Morgan’s Cloud is the boom preventer—way more important than the $450 worth of prescription drugs I just picked up from the pharmacy.
By the same lights, our most important medical training is to always rig said preventer when the wind is aft of the beam and to always be looking out for, avoiding and maintaining things that could break and injure us.
In other words, good seamanship trumps first aid training and equipment every time. Of course good seamanship won’t help you not have a fatal heart attack, but two out of three ain’t bad.
Understand that I’m not advocating not having a good first aid kit and appropriate training, just that those things are not the primary way you will keep you and yours safe when offshore.
My wife and I have been licensed and active EMT’s for the last 17 years. I’ve had a more advanced license and my wife has been a CPR instructor. For the last couple of years, we’ve been giving “Medical Emergencies Onboard” talks at a variety of boating rendezvous, “fests”, and other boating events.
From our 9 years of cruising and EMT experience we narrowed the focus of what we think are the three most important things to consider in any medical emergency. It’s the main point of our first lecture in a series that we give. After giving the talk to about 1,000 boaters, no one yet has known what the first, most important thing to do is.
The three things are:
1. Scene safety. Having a medical emergency onboard is a terrible thing. In most cases, the total crew is a couple of people. If the second person is injured by jumping over hatches, getting exposed to the same thing that set the first emergency happening, or panic, it can turn the worst event of someone’s life into a catastrophe. Scene safety means making sure the boat is secure – injuries can happen when an anchor is retrieved thereby leaving the boat in an unstable state as just one example. There are many others. That second person is critically important in helping the injured person. The bottom line – while a medical emergency is terrible with life often on-the-line, it’s an unacceptable state for the boat to be found eventually with 2 dead bodies onboard.
2. Call for help. This is more important for coastal situations where a few minutes can make a big difference but it’s also important for getting instructions in all situations. A medical emergency onboard is a Mayday situation. You are much more likely to issue a Mayday due to a medical emergency than due to a vessel sinking. And yet most people wait too long and never consider calling it out. A Mayday is the proper thing – it’ll get medical assistance moving along with knowledgeable medical help on the radio. Call early. Call 911 if tied up at a marina. Use channel 16/Mayday if moving or at anchor. Also blast the horn randomly or in 5 blasts if at a marina or anchorage. You never know if that boat in the anchorage next to you is someone like us with the supplies and medical equipment of a small ambulance in their boat. We have and will respond to an obvious medical emergency like this. But only if we know it’s happening.
3. A-B-C. Airway, breathing, circulation. This is the basic beginning of CPR training. In general, if you have help on the radio or phone, they’ll guide you through this. It’s always better to have taken a CPR class though – and you need to re-take it every couple of years. The card you get even has an expiration date.
Ultimately, your posting is right on. It’s way better to prevent an emergency in all cases. But there are some things that can’t be prevented. Knowing what to do, staying calm, and being safe about it are often the difference between life and death.
The first line of defense is good sense, the second good training, the third good equipment, the fourth good maintenance, the fifth is good practices, the sixth is self-confidence and the seventh is a willingness to call it quits when continuing no longer makes sense.
And still, bad things happen to good people.
But bad things occur with far greater frequency to the arrogant, stupid, immature and ill-trained operating the insufficient and badly maintained in spite of all indications a towel toss is called for.
And still, I have met far more sailors who have succumbed to the unpredictable vicissitudes of being ashore (or just aging) than to the manageable risks of being afloat.
While I fully agree with you about being prepared (I was an Air Scout, after all), I believe we let our fears get the better of us, and lately at an accelerating rate.
If we try to minimize our worst regrets, we may as well join that new human sub-species, the reality-dipping, broad-butted couch minder. If we ignore the risks completely, well, at least some part of paragraph three applies.
Somewhere for each of us there is that aurea mediocritas, that golden mean, that course between the extremes that leads to the rewards of reasonable risks met and bested. Reasonable can only be defined in terms of the individual. And history tells us reasonable waxes and wanes as life moves on.
John and Phyllis, I believe from having read your site from end to end, the two of you are the closest exemplars I can point to for persistently and humbly doing good things well.
Hi Chris,
Really good points as always in your comments. I really like your point about each of us finding our “golden mean” in balancing risk and reward. And thanks so much for the kind comment at the end.
I run a school with an extensive wilderness expedition program and I am frequently the voice at the other end of a Sat phone call from the field, albeit rarely for anything serious. Having been an EMT and now Wilderness First Responder, I have always been struck by how much of first aid was mostly common sense refined by a bit of science. In the heat of the moment the rigor of a strong system (e.g. ABCDE’s, SOAP notes, etc.) all work well to increase the quality of care and our confidence as care givers.
As we manage risk at our school, because we cannot eliminate it, we take especial note of situations with large transfers of energy. So in the mountains this is falls, heat, cold, moving water, and lightning – by seeking to mitigate both the likelihood (stay one body length away form the edge of a precipice so you can’t fall over) and the severity (wear appropriate clothing for the weather), we can very effectively manage the risks. It is theoretically possible that someone can fall while walking on a trail or the deck of a boat and get a tension Hemopneumothorax… but we don’t worry much about it.
So I applaud John’s approach of seeing a preventer as first aid gear. Since we humans last only minutes without oxygen I’d add keeping one’s head above water to the list via appropriate systems. Exposure, mostly cold in our realm, is an insidious risk in that the decline decreases one’s decision making efficacy and efficiency – hence the locker of dry hats, mittens, extra sweaters, and the power of hot drinks would collectively be of equivalent importance as the preventer in my book.
For most of us on this site we are seeking out the very places beyond the reach of Advance Life Support, etc… and the outcome of a serious incident will be determined in the first hour or so – either you will die or you won’t… and for us Wilderness First Aid is about quality long term care for evacuating a patient to higher care over extended periods of time, really good cuts and scrapes wound care, and enough knowledge that we can effectively use other resources for stuff like an acute abdomen.
Hi Christopher,
A great comment, thanks. Lots of good points for anyone that goes to remote places, by sea or land.
John, I could not agree more about the importance of a boom preventer. On Alchemy our boom is always prevented, even if close hauled with the boom over the traveler. One might think that the boom would be tamed in that state but a sail shiver (caused by a wind shift of a moment’s duration) can still move the boom a few inches with the force of a sledge hammer. A very good argument from a Fleet Surgeon’s point of view can be had on the web site of the Cruising Club of America. Even better is that there is also a very workable solution that most vessels can execute without undo expense or bother. Dick Stevenson, s/v Alchemy, Bayona, Spain
I’m an emergency medicine physician with far-away river running experience and obviously a desire to experience sailing because I’ve spent hours reading this excellent AAC site. I agree entirely that prevention is the best strategy for injury/illness avoidance. Because not everything is avoidable (Mister Gravity unfortunately rules), my backcountry medical kit has evolved to care for predominantly the following problems: severe allergic reactions, pain management/fracture alignment, wound care, and simple volume loss. These are all readily treatable and when done well could make the difference between a relative inconvenience and a trip, or life, ending disaster. Learning about the tricks and goals of controlling bleeding is time well spent and is, in my opinion, more readily achievable for the lay person than the nuances of the ABCs. It is important to stress that well performed chest compressions can save lives when the pulseless victim is close to or onshore and advanced care rapidly available, so if that’s the cruising area, basic life support is well worth learning. In the end though, whether in the backcountry or the middle of the ocean, it is most important to have a practiced plan to stop the bleeding, keep the injured person as warm and comfortable as possible, replace volume as capable, and seek help/evacuation as the situation dictates.
Hi Paul,
All good points, and very much what we learned in our wilderness first aid course: https://www.morganscloud.com/2011/05/27/great-first-aid-course-for-offshore-voyagers/
The only exception was that in our course we were taught that the probability of resuscitation from CPR even with a hospital close by is sadly very low. Less than 5% if memory serves. That said I’s still a strong believer in CPR training.