Safety thoughts from medical pros


Our background of being registered nurses, volunteering with emergency services, and having been part of the emergency planning for a major medical center has helped us think about how to keep safe on our offshore Nordhavn 46, Salish Aire. Our experience has given us perhaps some unique perspectives. 

A great place to start, and which ties into our working experience, is a look at our medical gear. As RNs, we likely carry one of the larger first-aid kits on the water because we are familiar with how to use the supplies in it. A boat should always have medical supplies on board and at least one crewmember who is capable of using and will handle a medical emergency until it is reasonable to expect help to arrive. In our case, we often assume that help may be up to two days away, so we are prepared to handle significant emergencies. When we boated on the Salish Sea, we assumed we would have help within one hour and so we carried considerably fewer supplies. Another approach to addressing the needs of the crew and ship for longer-distance voyages is to travel with other boats that have crew or supplies on board that could be made available to you if needed. In any case, each voyage, boat and crew combination creates a different situation, and your emergency equipment and knowledge should be up to the task.

First-aid kit
Our current first-aid kit consists of a large waterproof case that we have loaded ourselves. However, you can also find companies online that make cruising-quality first-aid kits. Our kit includes:

  • Blood pressure cuff and stethoscope
  • Otoscope
  • Various medical “clamps” and scissors
  • Surgical glue
  • Suture supplies
  • IV solution and IV supplies (catheters and tubing)
  • Saline wash for wounds, eyes, etc.
  • Armboard for supporting a fracture
  • Women’s sanitary napkins for use as absorbent dressings for heavy wounds
  • Coagulation powder
  • Various gauze dressings for wound care 
  • Oxygen saturation meter
  • Simple adhesive bandages
  • Wide-spectrum antibiotics, seasickness pills, NSAIDs and Tylenol, and rehydration salts that can be mixed with water 

An abandon-ship checklist is posted at the main pilothouse exit.

We also carry a medical oxygen tank and supplies to support it, as well as an AED. A basic first-aid course would be good since bumps and cuts are common; broken bones are less common, but understanding how to cope with these occurrences can decrease anxiety while aboard.

Never discount what you can learn from others no matter how many years of experience you have. We have always been willing to listen to people with more experience than us and then evaluate if what they have said makes sense in our individual situation.

Capabilities of the boat
The capabilities of the boat itself need to be considered carefully. When we had a 26-foot trailered sailboat, we had to always keep in mind the limitations of the vessel. We were able to take it from Vancouver to Skagway via the Inside Passage, but only because we took our time and carefully watched the weather to make sure we would have sea conditions that were within the capability of the vessel. Recently we took Salish Aire down the West Coast from Seattle to Puerto Vallarta. She is a heavy boat made for open-water cruising. Our rule of thumb when it comes to the boat is that it should be able to handle heavier water than we expect to use it in, or we should come up with a different plan.

When we plan our trips, we carefully consider our abilities and the boat’s capabilities, and then we look at the conditions we expect to find on our voyage. As a rule, we try to always plan for the worst and hope for the best. Recently, while transiting north from Mexico back into the waters of the U.S., we kept watching for a “perfect” weather window and after a while realized it wasn’t going to happen. We have experienced headwinds as high as 35 knots for extended periods of time, so we knew the crew and the boat could handle those conditions, even if they made us physically very uncomfortable. In the end, the winds were in the 15- to 20-knot range most of the way, with periods of lower winds and periods as high as 25 knots. These were not the conditions we hoped for, but they were within our expectations and abilities. So, while the voyage was not one we hope to repeat from a comfort standpoint, it was a safe transit.

Accidents happen — an offshore log damaged the stabilizer on Salish Aire.

Staying with the concept of safety being situational, this also applies to what we choose to carry for safety equipment. In Alaska, we were always aware that the water temperature alone could be fatal, so we carried exposure suits on Salish Aire and fire-making supplies aboard the dinghy when we went ashore. In our summer in Mexico, a gallon of fresh drinking water was always aboard the dinghy; while in winter in the protected waters of Puget Sound, we make sure our foul weather gear is ready to keep us warm and dry.

Fire a fearsome peril
I believe that the risk of fire deserves a special mention in any discussion about safety on the water. With my experience as a volunteer firefighter, I have seen fire up close and personal, and I fear it on a boat more than any other peril that we commonly face. This is one area that I believe the Coast Guard minimums are inadequate for my comfort. Carry plenty of large (at least 5-pound) ABC-type dry chemical extinguishers (smaller extinguishers empty within seconds!) for general fires.

While we were pretty laissez-faire about staying warm in the 90-degree waters of the Sea of Cortez, we don’t ever want to forget the dangers of falling overboard in more northern waters. The “1-10-1” rule reminds cold-water boaters that if you fall in the water, in the first minute you will experience cold shock, followed by 10 minutes of quickly losing the ability to swim and/or self-rescue, followed by one hour of time before hypothermia causes you to fall unconscious.

It’s best to have plenty of big, accessible and well-maintained fire extinguishers.

Communications in an emergency at sea can be critical if the boat or a crewmember is at risk. Communications can also add comfort for family and friends keeping track of your voyage, or for crew who have vulnerable family members left ashore. For communications when we are in coastal areas, we always have a permanently mounted 25-watt marine VHF with a good antenna system on the boat. Once we are entering areas where we are not as likely to be able to summon help via VHF, we make sure we have a satellite communicator of some kind and a high-frequency (marine SSB or ham) radio on board and are comfortable with using it. We also use our inReach satellite unit to leave periodic “bread crumb” messages for persons following our voyage, who can then compare our actual path with the float plan we have communicated to them before leaving so they can alert authorities if we are overdue at our next port of call. Finally, we carry a self-launching EPIRB and a personal locator beacon (PLB) for when we are away from the boat. A cellphone should not be considered as a first-line means of on-the-water emergency communication; see “Safety rests on preparation,” September/October 2019, Issue 257.

One of the most important concepts for staying as safe as possible in a potentially hazardous environment is crew communication. After 43 years of marriage, Clarice and I often depend on nonverbal communication when we are completing a task. But, even with that level of familiarity, we know that we need to speak clearly with each other about our plans and actions. In our work in emergency and medical services, and in working with amateur radio, we have been taught to constantly repeat back key information during critical communications until it has become second nature. For example, I cannot see the stern of Salish Aire when we back into a slip, so the conversation goes something like this when we need to make this somewhat difficult maneuver: 

Clarice: “Move the stern to port, we are six feet from finger pier.” 

Norman: “Stern to port, six feet from the dock. Boat in neutral.” 

Clarice: “Boat in neutral.” 

A VHF radio with emergency communication instructions posted alongside.

And so forth. We find that in a real emergency, this level of communication comes naturally because we use it daily, with the result being we function much better as a team and are able to keep mind-sapping panic at bay.

In evaluating our boat and the voyage we plan to take, we look at the equipment we carry aboard and determine if we have what we need or if we need to consider adding additional safety devices. When we purchased Salish Aire as our first truly offshore boat, we made sure that the life raft that came with the sale was serviced and ready to be used if/when we need it.

None of the items that are built into a ship or are carried aboard are worth the amount they reduce your freeboard if they are not maintained and you are not familiar with using them. Even on our top-of-the-line Nordhavn, we have found electrical connections that have corroded over the 20-plus years since she left the shipyard. If those connections are ignored, they have a high chance of leading to us being stranded by a failed critical system — or even worse, they can lead to a shipboard fire at sea.

Visualize your response
It’s important to visualize what you will do in an emergency and practice when possible. When I am alone in my thoughts, I will visualize what I think I would do in a specific emergency situation. For instance, if we hit a log that puts a hole in the hull, what would we do to evaluate if there was a leak and where the water was coming in? Then I ask myself what I might do to control a leak if the bilge pumps were keeping us from a rapid sinking, and where the supplies I would need are stored on the boat. Should the leak get out of hand, what would I do to prepare for going overboard, including a mental review of sending out distress calls on the VHF, SSB and satellite messenger devices. I ask myself if I know where the life raft is stored, as well as the survival suits and ditch bag, and mentally review what we learned when we had the life raft repacked and were given a class on how it should be used by the repacking company. I am likely to review the evacuation checklist that hangs next to the pilothouse door. Finally, Clarice and I discuss and compare our mental plans to make sure we both agree that we would be able to coordinate our efforts in the thick of an emergency.

Even the youngest members of the crew of SV Xpression are licensed HAM operators and regularly practice their radio skills (photo by CR Hegewald).

Another important concept to consider is “situational awareness.” Situational awareness means that you are keeping track of everything around you that might affect your safety, and then making preparations before a problem occurs. A sailor who reduces sail when they see a squall approaching but before they have a knockdown is demonstrating this concept. A captain who notes that a fire extinguisher’s pressure gauge is at the low end of the green zone, making a note to have it serviced the next time the boat is in port, is demonstrating this concept. A crewmember who sees that the helmsperson is too exhausted to maintain a safe watch and offers to help out is also demonstrating it. The idea of safety on a boat is not simply carrying the latest and greatest safety equipment, but rather it is about making sure you know your boat’s capabilities, your capabilities and your crews’ capabilities, and having the right (properly maintained) safety gear on board as well as the knowledge of how to use it in the situations you are likely to encounter on your voyage.

So, how does this all flow in a real emergency? Well, we were traveling south 10 hours out of our next planned stop in San Francisco when we hit a very large log. We didn’t need to alert or wake the crew, as we were both in the pilothouse during daylight hours when the log made a thundering crash and the whole 60,000 pounds of boat shuddered. We didn’t panic when we heard the crash. We know the boat intimately, so we knew where to look for damage; we know her systems in detail, so we could evaluate if the damage we saw was likely to become catastrophic; we confirmed we were able to use our communications systems to reach out for help should the need arise, and we sought further knowledge when we realized we were missing a detail; we recognized the need to care for ourselves and got some deep sleep once it was safe; we were able to use systems such as our paravanes and anchor in the dark because we had practiced with them; and finally, we communicated with each other continuously to make sure that we worked smoothly as a team.

We often hear the comment that we should feel pretty comfortable with our ability to handle medical emergencies on board with more than 80 years of nursing experience between us. What I don’t think is understood is that everything mentioned in this article to a great extent comes from those 80 years of experience. Ask your nurse friends what makes them valuable in any emergency, and they will commonly answer that we are taught and practice daily to not panic and to communicate and work our way through the problem. Avoiding problems with training and preparation, and then reacting when problems do occur with the calm that comes from practice —whether the issue is a broken leg or a fire in the galley — is what makes for a safe and able crew.

Norman and Clarice Gregory, both retired RNs, live aboard their 1996 Nordhavn 46, Salish Aire.

By Ocean Navigator