First Aid at Sea

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:

Motion sickness caused by conflicting signals between the vestibular system and visual input. Very common even in experienced sailors, especially in cross-swell or short steep waves. Almost always resolves as the body adapts.

Prevention

• Cinnarizine (Stugeron) 25mg: take 2 tablets the evening before sailing, then 1 tablet every 8 hours. Start early — it takes 2+ hours to reach therapeutic levels.
• Scopolamine patch: apply behind the ear 4–6 hours before sailing. Lasts 72 hours. Effective for many people. Side effects: dry mouth, blurred vision (avoid if driving).
• Avoid heavy, greasy or spicy food the night before and morning of sailing
• Avoid alcohol the night before
• Get good sleep

Treatment

• Stay on deck, in the cockpit. Do not go below — it will make you dramatically worse.
• Fix your gaze on the horizon. The distant horizon gives your vestibular system the reference it needs.
• Sit or recline amidships — the centre of the boat moves the least
• Sip water regularly — dehydration from vomiting worsens everything
• Dry crackers, ginger biscuits or ginger chews can help some people
• Avoid reading, screens, or looking at charts
• If you vomit: lean over the leeward side, rinse mouth with fresh water, rest

Recovery Position

If the person is very unwell and needs to lie down, use the cockpit sole or a cockpit seat on their side (recovery position). Never leave a seasick person unsupervised below deck — risk of aspiration if vomiting while alone.

These are two distinct conditions. Knowing the difference determines the urgency of your response.

Treatment — Heat Exhaustion

1. Move to shade immediately — below deck in air movement, not in direct sun
2. Lay them down and raise their legs slightly (improves blood flow to brain)
3. Remove excess clothing, loosen anything tight
4. Cool them: wet cloth on forehead, neck, armpits, wrists. Fan them.
5. Give cool water to sip — or oral rehydration salts. Not ice cold.
6. Monitor — should improve significantly within 30 minutes

Treatment — Heat Stroke

1. This is a medical emergency — cooling must be aggressive and immediate
2. Get them out of the sun and into shade immediately
3. Immerse in cool (not icy) seawater if available and safe to do so, or pour seawater over entire body
4. Wet sheets and fan continuously
5. Ice packs to armpits, groin and neck (where blood vessels are close to surface)
6. Do not give fluids if unconscious or confused — aspiration risk
7. Transmit Pan Pan and get medical advice — heat stroke can be fatal

Dehydration is extremely common on sailing trips. Hot sun, wind, physical activity and sea spray all increase fluid loss. Many people confuse dehydration symptoms with seasickness. The most reliable way to monitor hydration is urine colour — pale yellow is good, dark amber means drink now.

Signs of Dehydration

• Mild: thirst, dry mouth, darker urine, reduced urine frequency, slight headache
• Moderate: headache, fatigue, dizziness when standing, dry skin, muscle cramps, confusion in heat
• Severe: rapid heartbeat, rapid breathing, sunken eyes, no urination for 8+ hours, confusion or delirium — medical emergency

Treatment

• Oral rehydration: sip water steadily — don't chug large amounts which can cause vomiting. 150–200ml every 15 minutes.
• Oral rehydration salts (ORS sachets): dissolved in water, these replace electrolytes as well as fluid. Far more effective than plain water for moderate dehydration.
• Move to shade, rest, reduce physical activity
• Sports drinks can supplement but ORS sachets are better for medical rehydration
• Avoid alcohol when dehydrated — it dramatically worsens the situation

Saltwater wounds are at high risk of infection — sea water carries bacteria and debris. A minor cut that would barely need attention ashore can become a serious problem on a boat if not treated properly.

Cleaning the Wound

1. Put on nitrile gloves first — protect both patient and yourself
2. Stop bleeding: apply direct pressure with a clean gauze pad for 5–10 minutes without releasing. Do not keep checking — it disrupts clotting.
3. Once bleeding is controlled, irrigate the wound thoroughly with clean fresh water (or saline from the eye wash vials). Use a syringe or cup if available — forceful irrigation removes debris and bacteria far better than gentle rinsing.
4. Apply Betadine (povidone iodine) solution around but not deep into the wound. Dilute to a light tea colour before applying.
5. Do not use neat alcohol in a deep wound — it damages tissue

Wound Closure

• Steri-strips (butterfly closures): for gaping wounds not needing stitches. Dry the skin first, apply strips perpendicular to the wound, pulling the edges together. Cover with a non-stick dressing.
• Wounds that need stitches: any wound more than 1cm that cannot be held closed with strips, deep wounds, wounds on the hands/face, wounds with jagged or rolled edges. These need medical attention.
• Change dressings daily, or whenever wet or dirty. Re-clean each time.

Signs of Infection (Check Daily)

• Increasing redness, warmth and swelling around the wound after the first 24 hours
• Yellow or green discharge (pus)
• Red streaks extending from the wound edge (sign of spreading infection — serious)
• Fever, swollen lymph nodes, the person feels unwell systemically

Common in rocky areas throughout the Mediterranean. Sea urchin spines are brittle, barbed and can break off inside the skin. The immediate pain is sharp and burning. The real risk is infection and granuloma formation from retained spines.

Treatment

1. Do not squeeze or try to pull spines with your fingers — they are barbed and will break off further inside
2. Soak the affected area in warm water with vinegar (white wine vinegar) for 15–30 minutes — this softens the spines and helps dissolve calcium-based spines over time
3. With sterile tweezers (fine-point), carefully grip any visible spine as close to the skin as possible and draw it straight out in the direction it entered
4. Clean the wound thoroughly with Betadine solution after removal
5. Apply antibiotic ointment and cover with a clean dressing
6. Check daily for signs of infection

• Deeply embedded spines that break: do not dig for them. Broken spines often work their way out naturally over 1–2 weeks. Seek medical attention at the next port.
• Watch for signs of infection — sea urchin wounds are prone to it
• Ibuprofen can help with pain and inflammation

Jellyfish stings in the Mediterranean are usually unpleasant but not dangerous. The most common stinging jellyfish in Greek waters is the Pelagia noctiluca (mauve stinger) — painful but rarely severe. Rarely, severe allergic reactions (anaphylaxis) can occur.

Immediate Treatment

1. Rinse with seawater — NOT fresh water. Fresh water causes unfired nematocysts to discharge, worsening the sting. Use seawater only.
2. Do not rub the area — this also triggers more nematocyst discharge
3. Remove visible tentacles using tweezers, a credit card edge to scrape, or gloved fingers — never bare hands (you will sting yourself)
4. Apply vinegar to the sting area — neutralises remaining nematocysts for many species. If no vinegar, a paste of baking soda and seawater is an alternative.
5. Apply hydrocortisone cream or antihistamine cream to reduce inflammation and itch
6. Oral antihistamine (cetirizine) to reduce systemic response
7. Pain relief: ibuprofen or paracetamol

Signs of Serious Reaction (Anaphylaxis)

Sunburn at sea is more severe than on land — UV reflects off the water (increasing exposure by up to 25%) and the sea breeze masks the sensation of burning until it is too late. Prevention is vastly easier than treatment. SPF 50+ applied every 2 hours, reapplied after swimming, is the standard.

Treatment

• Cool the burn: cool (not icy) water or wet cloth held against the area for 10–15 minutes, repeated as needed
• Aloe vera gel (keep in the first aid kit): apply generously and frequently. Reduces inflammation and soothes pain significantly.
• Hydrocortisone cream 1% applied to burned areas 2–3 times daily reduces inflammation
• Ibuprofen addresses both pain and the inflammatory component of sunburn
• Increase fluid intake — burned skin loses fluid
• Cover the burned area completely for the rest of the trip — re-exposure dramatically worsens the damage
• At night: sleep on the unburned side, light loose cotton clothing over burned areas
• Do not pop blisters — if blisters form, the burn is severe. Keep covered and seek medical advice.

Hypothermia occurs when core body temperature drops below 35°C (95°F). In the Mediterranean, even in summer, cold water (typically 18–24°C in the Ionian) can cause hypothermia — the time to danger depends on water temperature, body fat, and activity, but even 22°C water can cause mild hypothermia after extended immersion. Night sailing in wet, windy conditions is also a risk even without immersion.

Treatment — Mild to Moderate

1. Get the person out of wind, water and cold immediately — below deck if possible
2. Remove all wet clothing — wet clothes accelerate heat loss even indoors
3. Passive rewarming first: wrap in dry blankets and sleeping bags from all sides. Cover the head (major heat loss point). Body-to-body contact inside a sleeping bag is effective.
4. Warm the space — close hatches, use any heating available
5. If conscious and able to swallow: warm (not hot) sweet drinks — hot chocolate, sweet tea. NOT alcohol.
6. Warm packs (or bottles of warm water wrapped in cloth) to armpits, groin and neck — where major blood vessels are close to the surface
7. Monitor continuously — check responsiveness every few minutes

What NOT to Do

• Do not rub the limbs vigorously — this drives cold blood from the extremities to the core, can cause cardiac arrest
• Do not give alcohol — it causes further vasodilation and heat loss
• Do not put in a hot bath — rapid rewarming can cause ventricular fibrillation
• Do not let them stand or walk unassisted — cold muscles and low blood pressure means fall risk; movement can trigger cardiac events in moderate hypothermia

Sprains and fractures most commonly occur from falls on deck, slipping in the companionway, or being thrown against fittings in a seaway. The foot and ankle are the most common injury sites on a boat.

RICE Protocol for Sprains

• Rest: stop activity, keep weight off the joint
• Ice: ice pack (or frozen food bag) wrapped in cloth — 15–20 minutes on, 15 off. Do not apply ice directly to skin.
• Compression: bandage firmly (not too tight — check circulation below the bandage every 30 minutes)
• Elevation: raise the limb above heart level when resting to reduce swelling

Suspected Fracture — Improvised Splinting

1. Check circulation, sensation and movement below the injury — if absent, this is an emergency
2. Do not attempt to straighten an angulated fracture — splint it as it is, unless circulation is absent
3. Splint the joint above and below the fracture — use the SAM splint from the kit, or improvise with a rolled sleeping mat, floorboards, or broom handle padded with clothing
4. Bandage the splint firmly in place — check circulation again after
5. Elevate if possible
6. Pain relief: ibuprofen and paracetamol together (different mechanisms, more effective in combination)

Head injuries on boats most commonly result from an unexpected gybe (the boom swings across and strikes someone), a fall below decks, or a collision. Even a "mild" blow to the head must be taken seriously.

Warning Signs — Never Ignore These

Concussion — Signs and Management

• Mild concussion: brief confusion, headache, dizziness, feeling "foggy", mild nausea — no loss of consciousness
• The WORSENING RULE: If any symptom — headache, confusion, nausea — is getting worse over time rather than better, this indicates possible intracranial bleeding. This is an emergency.
• Rest completely — no reading, screens, or activity that requires concentration
• Never leave a person with a head injury alone for the first 12 hours. Wake them every 2 hours at night and check that they respond normally and can tell you their name.
• Paracetamol for headache. Avoid ibuprofen and aspirin — they can increase bleeding risk.

A person who is choking cannot breathe, cannot speak, and will be clutching their throat. They may go blue around the lips. You have approximately 3–4 minutes before irreversible brain damage begins.

Heimlich Manoeuvre (Adults)

1. Stand behind the person. Ask them "Are you choking?" — if they cannot speak, answer yes, or are turning blue, act immediately.
2. Lean them forward slightly. Give 5 sharp back blows between the shoulder blades with the heel of your hand.
3. If the object has not dislodged: place both arms around their waist from behind.
4. Make a fist with one hand, thumb side in, positioned just above the navel and well below the breastbone.
5. Grab your fist with the other hand. Give 5 sharp inward-and-upward thrusts — hard and fast.
6. Alternate 5 back blows and 5 abdominal thrusts until the object is expelled or the person loses consciousness.
7. If they lose consciousness: lay them on the deck, start CPR. The chest compressions may dislodge the object. Look in the mouth before giving rescue breaths — remove any visible obstruction with a finger hook, but do not do blind finger sweeps.

Adult CPR Procedure

1. Check for response: tap shoulders, shout. No response? Shout for help.
2. Check breathing: tilt head back gently, lift chin, look/listen/feel for breath for no more than 10 seconds. Gasping or no breathing = start CPR.
3. Call for help — transmit Mayday, get coast guard on Channel 16. Do not leave the person alone to do this — delegate.
4. Chest compressions: heel of one hand on centre of chest (lower half of breastbone), other hand on top, fingers interlaced, arms straight. Compress 5–6cm deep at a rate of 100–120 per minute. Push hard. Push fast. Let the chest fully recoil between each compression.
5. After 30 compressions: tilt head back, lift chin, pinch nose closed, seal your lips around theirs and give 2 breaths — each lasting 1 second, enough to see the chest rise. Resume compressions immediately.
6. Continue without stopping. Switch compressors every 2 minutes if possible — compressions are exhausting and quality degrades after 2 minutes.
7. If an AED is available: apply it as soon as possible without interrupting compressions. Follow the voice prompts exactly. AEDs are straightforward — they tell you what to do.

When to Stop

• The person shows clear signs of life (movement, normal breathing)
• A more qualified person takes over
• You are physically unable to continue and no one else is available
• A doctor pronounces death — do not stop CPR on your own judgement at sea