Medical         Taking On Water        Grounding      Towing
   

Hyperthermia ( Heat Emergencies ) :  It is easy for a sailor to become dehydrated precipitating heat exhaustion, and if severe, dangerous heat stroke.  To prevent this from happening, wear a wide brim hat and drink plenty of water, at least two quarts to a gallon a day. 

Heat Exhaustion:  Prolonged exposure to the heat may produce symptoms of heavy sweating, a pale complexion, muscle cramps, tiredness, weakness, dizziness, headache, nausea, vomiting, and fainting.   The crew member should be moved to a shaded cool area and be rapidly cooled by any means possible.  Seek medical attention if the crew member has high blood pressure or heart disease or if symptoms are progressing.   DO NOT GIVE ALCOHOL

Search PubMed for Heat Exhaustion

Reference 1:  US Center for Disease Control :   Heat Exhaustion

Heat  Stroke:  Severe effects to heat exposure start to occur when the body's core temperature is above 103 F.   Symptoms are a lack of sweating, rapid strong pulse, throbbing headache, nausea, delirium and loss of consciousness.   Management includes calling for medical assistance and moving the affected crew member to a shaded cool area and be rapidly cooled by any means possible.   DO NOT GIVE ALCOHOL

Search PubMed for Heat Stroke   

Reference 2:  Bouchama A, Knochel JP.  Heat Stroke  N Engl J Med. 2002 Jun 20;346(25):1978-88.

Reference 3:  US Center for Disease Control :   Heat Stroke

Hypothermia : Prolonged exposure to the cold can lower the body’s core temperature producing dangerous hypothermia.   If you are sailing in cold water, hypothermia may be more of a danger to the person in the water than drowning, although one may lead to the other.   As the temperature of the water falls, the risk of hypothermia increases.  Neoprene and fleece are two materials which help to insulate the body even when wet.  Most synthetic materials will not insulate a person in the water.  Most of the heat loss occurs through the head. One should wear a wool of fleece lined hat in cool weather.  Thus, it is important to keep the entire head out of the water.

Time period a person can survive in the following water temperatures ( Ref 4).

  70 degrees - 18  hrs with PDF, 13 hrs treading water, 10 hrs swimming
  55 degrees - 3.5  hrs with PDF,  3 hrs treading water,  2 hrs swimming
  35 degrees - 1.75  hrs with PDF,  1.25 hrs treading water,  0.75 hrs swimming

The diagram on the  right is an immersion survival chart from the USCG Office of Boating Safety.
(Click on chart to enlarge )
  
  
 

 
To maximize survival, do not swim.  Conserve heat by keeping your knees drawn up to keep your body as small as possible.

When the body temperature approaches 94 degrees hypothermia may start.  Early signs that the body is starting to cool is shivering and goose bumps.  As the core body temperature lowers further the shivering stops and symptoms of slurred speech, difficulty walking, loss of dexterity and decreased mental performance begin to appear.  As the temperature drops below 86 degrees F, severe hypothermia sets in, muscle rigidity, loss of consciousness and ventricular fibrillation may occur.  Death is near.  Blood pressure and pulse may not be detected, thus never assume the crew member has died.  In cases of hypothermia, always resuscitate. (Ref 5)

The treatment is to slowly warm the crew member.  Faster warming, rubbing the arms and giving stimulants such as caffeine may cause harm and induce dangerous cardiac arrhythmias.  A medical emergency exists if changes in consciousness or delirium are present. 

Search PubMed for Hypothermia

Reference 4:  US Coast Guard Auxiliary 8th District, Western Rivers Region, Division 5, Flotilla 6 Beaver Lake, Arkansas

Reference 5:  Weinberg AD: Hypothermia. Ann Emergency  Medicine 1993;22( 2):370-377.

Reference 6:  USA Center For Disease Control:  Hypothermia

Seasickness :  The brain uses a variety of inputs to control balance.  Two of the most important are the inner ear and the eyes.  When input between these two organs do not match disequilibrium occurs and seasickness may develop.  It commonly occurs when a crew member is trying to read or do chart work down below.  The first step to the treatment of seasickness is to take the crew member to the cockpit and have him look to the horizon.  This may relieve the majority of seasick individuals.  If possible, it is better to do chart work in the cockpit with frequent gazes to the horizon to prevent seasickness.

Scopolamine patches.  This drug is an “anti-cholinergic” and is commonly used to relieve the nausea associated with seasickness.  They should never be used without the direction of a physician.  They can make glaucoma worse with the acute loss of vision, produce acute urinary retention in crew members with prostrate problems and can commonly cause psychosis in the elderly.

Bonine (Antivert) and Dramamine.   These  drugs are much safer than scopolamine patches and may be obtained without a prescription.  The incidence of side effects are less.  However, they will make the crew member drowsy and also have some anti-cholinergic properties, which can rarely give rise to the side effects found with the Scopolamine patches.

First Aid Kit:  All boats should have a first aid kit and manual.  The following are items which can be obtained over the counter at a pharmacy.

--A book on First Aid and and CPR Reference Sheet
--Dramamine and Bonine for seasickness.
--Aspirin for pain relief.  Also will reduce the
mortality of a heart attack by 50%.
--Antihistamines (without a decongestant) to
treat allergic reactions.
--Anti-acids and Zantac for heartburn.
--Milk of Magnesia.
--Antibiotic Ointment.
--Hydrogen Peroxide.
--Band-Aids, Gauze pads, and butterfly Band-Aids.
--Tape.
--Splints & Tourniquets
--Burn Dressings.
  

On one sailing trip on Lake Erie, the boat was about 1.5 nautical miles offshore and 5 nautical miles from the dock when an alarm sounded (see picture to the right).   Since the boat was under sail, the alarm was not related to the engine and a quick check of the bilge pump through-hull showed extensive water being pumped out (see middle picture ).  Removal of the floorboards showed a high rising waterline.  The waterline was immediately marked to determine if it was rising.  ( After a pullout, the source of the leak was found to be a 2" by 3/16" opening between the planks of the wooden hull. )  Because the water was rising the manual sump pump was placed in the bilge and manual pumping begun.  The through-hull of the raw-water system was closed and the raw-water intake line was placed into the bilge.  ( You must have a clean bilge so debris does not enter and clog the raw water system resulting in overheating and loss of the use of the engine. )  The engine was turned on which started to pump the water out of the bilge, allowing us to motor-sail and also recharge the battery that was running the bilge pump.  The water level then began to fall ( see bottom picture ). 
   
The leak was not found until after we reached port, however if it had been discovered it should have been stuffed with bedding, towels, clothing or other material to bring it under control.  Larger leaks may sometimes be controlled by draping a sail over the outside of the hull and securing it with lines to each side of the deck.  

If you need to abandon ship, do so only when you can step up to the life raft.  If possible stay with the floating boat.  It is a much larger target for rescue crew to find than either a person in the water or life raft.

Safety measures to take before leaving port include:  1) Having an upgraded bilge pump installed on the boat.  2) Prepare a diagram of all through-hull locations along with the locations of flares, EPIRB, fire extinguishers and PFDs. readily available.  3) Liferafts:  How to prepare provisions and what to take on a life raft is beyond the scope of this course.  Obviously, the advice would be much different between sailing on an inland lake within sight of shore versus on the high seas where water provisions and survival may become the challenge of your lifetime.
 

By using the engine in reverse and backing the jib or main you may be able to release the boat.  If you are unable to back away by sail or motor, drop an anchor to prevent waves or current from pushing the boat further aground.  In hard groundings, inspect the shaft and prop.  If these were damaged in the grounding, then operation will further damage the boat. 
 
To kedge off is to place an anchor to pull the boat off a shoal and into deeper water.   The anchor is taken out a distance with a dinghy to a proper scope of (7:1).  Tighten the rode as the boat is moved back and forth by the waves or use a winch or, if present, the anchor’s windlass to pull the boat off the shoal.  Use of the winch may also heel the boat and raise the keel off of the bottom.   DO NOT STAND BEHIND THE RODE.  If the rode breaks, the whipping action of the line can cause serious injury.

Another method to heel the boat over is to place the weight of a crew member at the end of the boom and swing the boom parallel to the beam.    
 
If you are in a tidal zone, check the tide tables, things may be getting worse if the tide is letting out.   In this case, one should try, if can be done safely, to place cushions between the hull and the bottom.  However, if waves are bouncing a several ton boat, this may be far too dangerous to consider.  If the tide is coming in, you may be in luck.  Using a dinghy, just drop an anchor away  from shore and wait for the tide to come in.  If you do not drop an anchor, the incoming tide may continue to push the boat further onto the shoal.
 
As a last resort, a “Halyard Pull” can be used to pull the boat off the shoal.  This produces the most leverage on the vessel and extensively heels the boat which reduces its draft, allowing it to be pulled off the shoal.  However, this maneuver may damage or break the halyard since it is not designed to do this.
   

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