Medical Emergency.
You should know the medical history and condition of your crew before the lines come off. Pick the right condition — every minute spent on the wrong procedure is a minute the right one isn't being followed.
Which kind of medical emergency?
Pick the condition. Each one is its own short procedure. When in doubt, transmit a Pan-Pan and ask for medical advice early.
Drowning
Unresponsive after submersion or near-submersion.
Go to steps ↓Chest pain
Pressure, tightness, or radiating pain in the chest.
Go to steps ↓Head injury
Blow, fall, or impact to the head.
Go to steps ↓Limb injury
Bleeding, broken bone, or wound on arm or leg.
Go to steps ↓Body trauma
Hard impact to torso, possible internal damage.
Go to steps ↓Burns
Heat, flame, or sun damage to the skin.
Go to steps ↓Hypothermia & heat
Body temperature too cold or too hot.
Go to steps ↓Seasickness
Nausea, vomiting, lethargy from motion.
Go to steps ↓Allergy & stings
Reaction to bite, sting, food, or contact.
Go to steps ↓Immediate — stabilize, start CPR.
Place the victim on a hard, flat surface and start CPR. If hypothermia is suspected, once stable remove wet clothing and cover with a dry warm blanket.
Shake the victim and shout "Can you hear me?"
If no response — do not delay, do not check for breathing or pulse — begin CPR.
Have a crew member establish Mayday contact. State that CPR is in progress.
↗14Emergency CommunicationsOpen the airway — head tilt, chin lift.
- Give two breaths sufficient to make the chest rise
- Breaths are about 1 second each
- Be sure the chest rises with each ventilation
Chest compressions — middle of the chest, nipple line, 100 / minute.
Cycle 30 compressions then 2 ventilations, about 3 cycles per minute. Continue this 30:2 cycle for about 2 minutes between checks.
If an AED is available, use it now.
Follow the device prompts. Continue compressions between shocks.
If you are alone:
Place the Mayday call after the first two minutes of CPR, then return to CPR as quickly as possible.
Immediate — out of the elements, warm and comfortable.
Get the victim out of the wind and spray. Make them comfortable and warm. Begin the interview while you stabilize.
Determine — ask about:
- History of heart disease, heartburn, or similar chest pain
- Medications used for these problems
- Location and radiation of the pain
- Description and severity
- Inciting event
- What makes it better or worse
Pain from an isolated physical event, or localised, made worse or better by movement or body position.
- Immobilise or rest
- Ibuprofen
- Narcotics if severe
Pain beneath the breastbone or upper stomach, linked to recent food or alcohol, relieved by an antacid.
- Antacid for immediate relief
- Begin acid-reducing medication (omeprazole, ranitidine)
- Avoid alcohol, coffee, chocolate, citrus, tomato sauces
If pain is severe, beneath the breastbone, and radiates to left neck, shoulder, or arm — treat as heart attack.
Other indicators: pallor, sweating, anxiety, sense of doom, nausea, rapid or irregular pulse, shallow fast breathing.
Immediate — immobilize the neck.
- Immobilise the neck
- Make the crew member comfortable
- If unconscious, place the victim on their side
Bleeding from ear or nose without trauma to the nose?
Suspect skull fracture. Call Pan-Pan for medical advice.
↗14Emergency CommunicationsConscious? Check extremities for movement and sensation.
Check every 2 hours for: change in alertness, drowsiness, confusion; difficulty with speech; unequal pupils; asymmetrical grip or inability to move extremities; worsening headache.
Deterioration on the 2-hour check?
Call Mayday for evacuation.
Bleeding — direct pressure stops most bleeding.
Apply direct pressure to the wound.
- Initially: palm + clean towel or cloth
- Then: sterile injury pad, direct pressure
- Elevate the injured limb
If bleeding persists: don't remove the pad. Add more, add pressure.
Apply a pressure bandage (elastic wrap or Coban) to replace hand pressure. If swelling, numbness, pins-and-needles, or white/purple skin appears near the bandage — reduce pressure.
Still bleeding? Add pressure on the arterial pressure point between the injury and the heart.
Call Pan-Pan for medical advice.
↗14Emergency CommunicationsTourniquets are a last resort, with medical advice only.
- Call Mayday for evacuation
- Once applied, do not loosen or remove without medical advice
- Observe for shock: rapid shallow breathing, pallor, sweating, cold extremities, confusion, restlessness, thready pulse, low blood pressure
Broken — splint, then check for danger signs.
Indicators: a strong blow or fall on the extremity; pain on use or weight-bearing.
Immobilise with a splint. Give pain relief.
Check for danger signs:
- Misalignment of the limb
- Visible bone
- Inability to move the extremity through its full range
- Loss of sensation distant from the injury
- Pallor or bluish colour distant from the injury
Continue splinting. Observe for developing danger signs. Gradually resume use of the limb.
Immediate — comfortable, warm, dry.
A hard blow or fall to the body that may have caused internal organ damage or bleeding. Place the person in a comfortable position; keep them warm and dry while you check.
Signs of internal bleeding:
- Vomiting of blood, or coffee-ground-like material
- Coughing up blood or bloody froth
- Bloody or black tar-like stools
- Rigid, painful abdomen
- Pain with breathing, shortness of breath
- Weak pulse, systolic blood pressure under 100
- Light-headedness, confusion, restlessness, anxiety
Check for pulse and breathing. Begin CPR if either is absent.
See the Drowning steps above for the CPR cadence (30:2).
If any signs of internal bleeding are present:
Call Pan-Pan and seek medical advice.
↗14Emergency CommunicationsJudge it — depth and extent.
Most burns on boats come from sun, heat, or flame. Goals: reduce pain, protect against infection, get medical attention as needed.
- 1st degree (superficial) — outer skin only (sunburn)
- 2nd degree (partial thickness) — outer + inner skin, blistering or weeping (hot-water scald)
- 3rd degree (full thickness) — through skin to fat or muscle; waxy, pearly grey, or charred (clothing fire)
One palm of the victim ≈ 1% of total body surface area. Use it as your ruler.
Immediate — remove, cool, medicate.
- Remove the cause of the burn
- Cool the area with clean water
- Give pain medication as needed (ibuprofen, acetaminophen, narcotics)
1st degree (superficial).
Topical moisturizer, aloe vera gel, topical pain relievers, ibuprofen or acetaminophen.
2nd degree, limited (<1% surface area).
May be treated as 1st degree. Do not open the blister — it protects from infection. Apply Silvadene cream and keep covered with a sterile non-adhesive dressing, changed daily.
2nd degree, larger (1–20% surface area).
Treat as limited 2nd degree.
3rd degree full thickness, OR 2nd degree >20% surface area.
Treat as limited 2nd degree, then call Pan-Pan for medical advice and prepare for evacuation.
↗14Emergency CommunicationsConfusion / lethargy — two opposite causes.
Gradual loss of judgement, ability to follow instructions, interest, or slurred speech. Cold or heat are the two environmental causes you'll meet at sea.
Hypothermia — wet, cold, can't talk clearly.
Mental confusion, inability to walk or perform physical tasks after immersion or exposure to severe cold or wet. Oral temperature <95 °F / <35 °C. Shivering, slurred speech.
Get warm.
- Remove from the elements to a warm area
- Remove wet clothing; dress in dry warm clothing
- Wrap in a dry blanket or metallic warming blanket
- Encourage warm liquids — do NOT administer alcohol
- Apply hot water bottles to armpits and groin
If still very confused and not responding to the above:
Obtain medical advice and consider evacuation.
↗14Emergency CommunicationsHeat stroke — hot, dry, stopped sweating.
Prolonged exposure to extreme heat, sometimes with high humidity or low water intake. Watch for progression:
- Heat cramps
- Heavy sweating
- Nausea, feeling faint
- Absence of sweating
- Hot dry skin; body temp >104 °F / >40 °C
- Confusion, disorientation, diminishing consciousness
Cool.
- Shelter the victim from heat
- Encourage fluid intake early — do not overhydrate
- Remove excess clothing
- Immerse in cool water, or cover with water-soaked clothing or towels
- Give sips of cool water
- In severe cases, ice around neck, armpits, flanks, and groin
More severe symptoms — seek medical advice.
↗14Emergency CommunicationsManage it before it becomes a real problem.
Vomiting and inability to keep liquids and food down due to vessel motion, resulting in dehydration. Prolonged seasickness can lead to severe dehydration, confusion, and lethargy.
Offer options that don't interfere with vessel operations.
- Steering — eyes on the horizon
- Resting below, well secured
- Staying out of the way while they cope
Manage the environment.
- Avoid strong odours (diesel, waste)
- Keep the individual warm and dry
Medications.
Medications are less effective after onset. Susceptible individuals should start them 24 hours before the voyage. Try the medication ashore first; options include Stugeron, transdermal scopolamine, cinnarizine, diphenhydramine.
Allergic reactions — stabilize, remove the cause.
Localized reactions are generally not life-threatening. Generalized reactions can be. Watch for: extensive hives or itching; swelling of eyelids, lips, tongue; difficulty breathing or tightness of the throat; pallor, thready pulse.
Interview, if possible.
- History of the precipitating event (food, sting, etc.)
- Prior similar episodes
- Personal medications available
Treat.
- Administer an adrenalin injection (Anakit, EpiPen) if available
- Administer an antihistamine by mouth (chlorpheniramine in Anakit, or diphenhydramine)
- Repeat adrenalin in 30–60 minutes if symptoms return
- Repeat antihistamine in 2–4 hours if symptoms persist or return
Insect & marine stings — two very different treatments.
- Remove the stinger if visible
- Apply an ice pack or cooling for 30 minutes for pain relief
- Ibuprofen or acetaminophen as needed
- If swelling, an antihistamine (chlorpheniramine, diphenhydramine)
- Remove tentacles or debris without touching with bare hands
- Wash with copious amounts of salt water
- Do NOT use vinegar, meat tenderizer, or urine — in some stings this releases additional toxin
- Scrape the area with a credit card, or shave with shaving cream and a razor, to remove remaining stinging cells
- Pain relief with ibuprofen or acetaminophen
Gear for this moment.
The equipment we'd want aboard if this alarm went off right now. Each piece earns its place against a specific step above.
On a sudden cardiac arrest offshore, an AED is the single piece of kit that changes the odds. Marine-rated, checked, and everyone knows where it is.
View gearSterile pads, pressure bandages, and a tourniquet for the last resort. Direct pressure stops most bleeds — have what you press with.
View gearThe medications and the guidance this procedure references, in one grab-bag — plus the book that walks a non-medic through using them.
View gearSeaWise may earn a small commission on these links — it helps keep the procedures free. We only list gear we'd carry ourselves.
Skipper notes.
No notes yet. If you've run this procedure for real, your note could be the one that helps the next skipper.
+Add a note