Marine First Aid

On the water, you are the first responder. An ambulance can't drive to your boat, the cell signal may be gone, and the Coast Guard or a marine unit could be an hour or more away. Add a rolling deck, a cramped cockpit and cold water, and first aid afloat takes a little more planning than first aid at home. These four basics cover what every skipper and crew should know.

1. Carry a Marine First Aid Kit

Every boat needs a first aid kit packed for wet conditions. Start with:

Waterproof bandages and dressings, plus gauze and tape that still sticks when damp
Antiseptic wipes and a wound-cleaning solution or saline to flush out cuts
Instant cold packs for sprains, bumps and swelling
Seasickness medication, taken before you leave the dock; it works poorly once someone is already sick
A CPR pocket mask and disposable gloves
An emergency thermal blanket to help warm someone who is wet and cold

Worth adding: a tourniquet and trauma shears, tweezers and side cutters for fish hooks, burn gel, sunscreen, eye wash, a splint, pain relievers, everyone's personal medications (such as an epinephrine auto-injector or an inhaler) and a first aid guide.

Keep it dry and within reach. Pack it in a waterproof case or dry bag, store it where anyone aboard can grab it fast rather than at the bottom of a locker, and show your crew where it is before you leave. Check it at the start of each season and after every use, and replace anything used up or past its expiry date.

2. Know Cold Water Shock and Hypothermia

Lakes and coastal waters across Ontario, the Great Lakes and much of Canada and the northern U.S. stay cold well into summer, even when the air is warm. Falling in sets off two different emergencies.

Cold water shock hits the moment you go in: an involuntary gasp and fast, uncontrolled breathing. If your head is under water when you gasp, you can inhale water and drown. It passes in about a minute.
Hypothermia, a dangerous drop in body temperature, comes more slowly. Long before it sets in, cold muscles and nerves stop working, so you lose the strength to swim or hold on.

Remember 1-10-1: about 1 minute to get your breathing under control, about 10 minutes of useful movement to get out of the water or onto something that floats, and up to 1 hour before hypothermia makes you unconscious. A life jacket keeps you afloat through all three, which is why you should wear one, not just carry one.

Signs of hypothermia

Shivering, confusion and poor decisions
Slurred speech and drowsiness
Fumbling hands, stumbling and loss of coordination
Severe: shivering slows or stops, and the person becomes very drowsy or unresponsive. This is a medical emergency.

What to do

Handle them gently and keep them lying down if you can. Rough handling can upset the heart rhythm of someone with severe hypothermia.
Get them out of the wind and water, into a cabin or other sheltered space, as soon as possible.
Swap wet clothes for dry layers, cutting the wet clothing off if that's easier, then wrap them in blankets, a sleeping bag and the thermal blanket. Cover the head and neck.
Warm the core first. Heat packs or warm water bottles, wrapped in cloth, can go against the chest, armpits and groin.
Don't rub or massage their skin or arms and legs, and don't put them in a hot shower. Both can make things worse.
Give warm, sweet drinks only if they're fully alert and able to swallow, and never alcohol.
Get medical help right away if the signs are severe or getting worse, and call for help early rather than late.

3. Learn CPR and How to Use an AED Afloat

Drowning and sudden cardiac arrest are two of the most serious emergencies on the water. Starting CPR right away, and using an AED (automated external defibrillator) if one is available, gives the person the best chance of surviving. CPR on a boat isn't quite the same as CPR on a living room floor:

Find a firm, flat surface, such as the cockpit sole or the deck. Compressions on a cushion, berth or trampoline don't work.
Steady the boat. Slow down or heave to, and give each person a job: one steers, one calls for help, one or two take turns on CPR.
Drowning is a breathing emergency, so rescue breaths matter. Follow your training, which may tell you to start with breaths before compressions.
Using an AED around water: get the person out of the water and onto the driest surface you can, wipe their chest dry, keep the pads clear of puddles, and make sure nobody is touching them when the AED delivers a shock. Know where the nearest AED is at your marina or club.
Unconscious but breathing? Put them in the recovery position. In a tight cabin or cockpit, wedge cushions or bags around them so they don't roll with the boat, and keep watching their breathing.

Take a course. A marine first aid course teaches these skills in conditions like yours: CPR on a moving, unsteady surface, using an AED around water, and moving and positioning someone in a confined space aboard. In Canada, the Canadian Red Cross offers a Transport Canada-approved Marine Basic First Aid course. Any first aid and CPR course from the Red Cross, St. John Ambulance or the Lifesaving Society is a great start. See our Top 10 CPR & First Aid Safety Tips.

4. Call for Help on a Marine VHF Radio

Calling 911 isn't always an option on the water. Cell phones often lose service on big lakes, rivers and the coast, and a phone call can't reach the boats close enough to help. A marine VHF radio can.

Use VHF channel 16, the international distress, safety and calling channel. The Coast Guard and nearby boats listen to it.
Use DSC if you have it. On a radio with Digital Selective Calling that's registered with an MMSI number and connected to GPS, pressing the red distress button sends an automatic alert with your position. Then follow up by voice on channel 16.
Know where you are. Give your GPS latitude and longitude if you can, or the name of the lake or river and your distance and direction from a landmark or the nearest point of land.
Use the right call. "MAYDAY" means a life or the boat is in grave and immediate danger: someone not breathing, unconscious or bleeding badly, a person overboard, fire or sinking. "PAN-PAN" means urgent but not immediately life-threatening, such as an injured crew member who needs help getting ashore.

How to make a MAYDAY call

"MAYDAY, MAYDAY, MAYDAY."
"This is" your boat's name, three times.
"MAYDAY" and your boat's name once more.
Your position.
What's wrong, for example, "Crew member not breathing, CPR in progress."
The help you need, and how many people are aboard.
Anything that helps them find you, such as the boat's size, type and colour.
"Over." Then release the button and listen.

Licensing: in Canada, anyone who operates a marine VHF radio, including a handheld, needs a Restricted Operator Certificate (Maritime), or ROC(M). The course and exam are run by CPS-ECP. In the U.S., recreational boaters don't need a licence to use a VHF radio in U.S. waters.

Common Injuries Aboard

Fish hooks: cover the point and get help ashore for a hook near the eye or deep in a joint. Otherwise, follow your first aid training, and keep side cutters in the kit.
Cuts and scrapes: flush them well with clean water. Wounds from coral, shells and fish can get infected easily.
Burns from the galley stove or a hot engine: cool them under clean, cool running water for at least 10 minutes.
Sun and heat: sunburn, dehydration and heat exhaustion come on fast with sun reflecting off the water. Drink often and shade up. See Environmental Emergencies.
Seasickness: keep the person in fresh air, looking at the horizon, and out of the cabin. Keep them sipping water. If they need to be sick over the side, have them clip on first, or hand them a bucket.
Head injuries from a swinging boom, and crushed fingers or rope burns from lines and winches: brief your crew before you leave, and watch for confusion or drowsiness after any blow to the head.

Before you go, file a float plan with Scan Your Plan, so someone ashore knows when to expect you back and help is sent if you don't check in.