Shipboard Medicine for the Sailor
Cruising and racing have different concerns
Over the years, many cruisers (both sailors and power boaters) have reported their experience with medicine aboard ship in remote oceans of the earth. Although acute injury from trauma and lack of fitness is possible on any boat, the primary concerns for cruisers tend be focused on being in exotic locations far from help especially when cruising short-handed. For racers, the situation is more sports medicine based, with real risk of trauma under extreme conditions where the boat and crew are being pushed to the max.
Recently, there has been growing interest in the rigors of racing and the injuries that can result. Who can forget the solo sailor who performed surgery on himself on the high seas? But what about the racer who doesn't go offshore? Until now, these issues were mainly taken up by healthcare professionals who happen to be sailors. A new review paper in the British Journal of Sports Medicine summarizes what has been studied and published to date.
Crew position on big boats has a lot to do with the risks.
Racing-related health concerns
Not surprisingly, injuries are not uncommon among racing sailors. They can happen as a result of lack of fitness, overuse, overtraining or trauma. Interestingly, the types of injuries most commonly sustained vary with the type of boat that's being sailed along with a host of other factors, including the crew position. Unlike a sport played in a consistent environment like tennis or baseball, sailing also takes place under a variety of disparate circumstances - from inshore dinghy racing to offshore circumnavigations - and varying weather conditions making it difficult to characterize the risks.
Dinghy sailors face sudden and harsh stresses that can cause injury.
Some generalities about risks to racing sailors can be made, however:
- On big boats, grinders and bowmen have the highest rates of injury, with back strain due to lifting sails or booms and repetitive position and motion while winching being most often at fault
- On small boats, knee, shoulder and back problems associated with hiking, sheet handling, and trapeze work take the greatest toll
- Fitness training is essential to maintain performance and reduce risk of injury, but overzealous sailing-related fitness training can also lead to off-water injuries
- Physiologic stresses are common, including erratic weight management, hydration, and nutrition
- Viral illnesses are common, spreading among teams members and competitors; other sailing related illnesses are those expected of outdoor water-borne activities including hyper- and hypo-thermia, sea sickness, sun overexposure
- Trauma (cuts and bruises) are three times more common in male sailors than in female sailors and far more common among dighy sailors than keelboat racers.
- Mental health can affect any sailor, especially after-race recovery and exposure to extreme conditions for distance racers
The bottom line is that there are risks in racing. To reduce those risks, sailors need to assess their boats, their crew positions, and their physiologic needs and develop a reasonable training program that will develop the body strength, agility and physiology to reduce the risks and enhance performance. And they have to stay on the boat and avoid the boom!
To read the full review by JB Allen and MR De Jong (Br. J. Sports Med. 2006; 40:587-593), please download the pdf here.
Cruisers often face short-handed situations that require strength and agility.
Cruising-related health concerns
Knowing basic first aid techniques can be very useful aboard a yacht.
Several wilderness medical specialists have written guides to medicine for the cruiser; after all the ocean is the ultimate wilderness. Anyone who crosses an ocean needs to understand that there are inherent risks involved. The primary risk is being far away from help when illness and injury occurs, so the primary emphasis is on prevention and self-sufficiency at sea. To assist, multiple services that provide radio and internet based medical advice from qualified shore-based physicians have become available. These are highly regarded and are in use by the shipping and cruise industries, as well as long-distance racers and cruisers.
Obviously, cruising in local waters is not as dangerous as crossing oceans, but you still may be a long time away from medical assistance if an acute illness or injury occurs. Many of us often sail short-handed which comes with its own set of variables, including lifting and boat handling issues in challenging weather conditions. That's when it pays to have some first aid training. Every sailor should take a Red Cross First Aid and CPR course. At least you'll be able to provide immediate assistance and relay the nature of the problem to authorities when you call for help. There are some things that we all should be prepared to handle:
- Recognize signs of hyper- and hypo-thermia and know what to do
- Clean and bandage a wound
- Support a broken limb
- Assess an unconscious victim
- Deal with seasickness, sunburn, and heat stroke
At least the physiologic and psychological stresses may be minimal (on most boats that is). Cruisers tend to relax a little more than racers. Nevertheless, on long passages a different set of psychological variables sets in and you may discover just how well you and your crew really get along.
A few years ago, Beth Leonard wrote about the experiences that she and her partner had with illness and injury during a circumnavigation. She wrote in Cruising World, "The medical log from our three-year circumnavigation shows that, while we were almost completely untroubled by colds and flus, we faced a much higher incidence of infections and allergic reactions." Below is the medical log. Beth worked with a physician to assemble a medical kit for her chosen itinerary.
From Cruising World, July 1997
Silk's Medical Log
7/92 - On passage to Azores: During dinner, the boat rolls through 30 degrees. Beth, in the galley, is thrown across the boat and cracks a rib on the nav table. For the next week at sea, pain is controlled with Tylenol with Codeine. Once in port, injury requires two weeks’ total rest, six weeks to heal completely.
3/93 - On passage to Galápagos: While taking a pill in a rolling sea, Beth starts to choke when boat rolls and pill lodges in her windpipe. Unable to speak or cough, she signals Evans, who administers Heimlich maneuver, dislodges pill.
2/94 - On passage in South Atlantic: Beth drops a slice of pizza on her leg. The hot cheese causes a deep second-degree burn. Treated with Silvadene cream and sterile bandage for several weeks, then left uncovered for short periods to dry.
3/93 - Panama: Beth wakes covered with hives and experiencing shortness of breath - possible reaction to medication. Self-treated with two 10-mg. tablets of Hismanal (antihistamine) to start and one every four hours for a day after.
5/93 - Marquesas, French Polynesia: Evans attacked by biting insects as he refills water tanks. His entire back is red, swollen, itchy. Self-treated with 10-mg tablets of Hismanal every four hours for several days until symptoms disappear.
7/94 - Mauritius, Indian Ocean: Evans develops itchy rash and hives while preparing to leave on passage for Reunion Island. Cause unknown. Self-treated with 25-mg tablets of Benadryl every four hours for 12 hours. Delayed passage until symptoms disappeared.
9/94 - On passage to Durban, S.A.: Beth develops painful, red, hot, swollen area on right hip. Red “fingers” radiate outward, spread across back. Durban doctor diagnoses allergic reaction to spider bite or jellyfish sting; prescribes 25 mg. Benadryl every four hours for two weeks, application of cortisone cream four times daily until symptoms vanish.
5/93 to 7/93 - French Polynesia: Beth suffers series of ear infections after snorkeling near coral. Symptoms begin between Galápagos and Marquesas on 29-day passage, recur three times over next two months. 1) Self-treated with 250 mg. of Amoxycillin three times per day for 10 days en route to Tahiti (June). 2) In Tahiti (June), infection results in 104-degree fever. Doctor administers injectable antibiotic and prescribes 500 mg. Augmentin twice a day for six days. 3) In Raiatea (July) symptoms recur. Doctor prescribes 900 mg. Bactrim Fort twice a day for 10 days.
5/93 - Marquesas, French Polynesia: Evans develops staph infection after swimming in Taiohae Baie. Self-treated with 250 mg. of Augmentin three times per day for 10 days.
11/94 - Durban, S.A.: During haul-out in polluted harbor, Evans dives to check keel’s position on cradle. One day later he develops severe fever and diarrhea that lasts for two days.Treated with bed rest, aspirin, water to prevent dehydration, bland foods as he recovers.