Before an offshore trip, it is easy to focus medical preparation on the worst-case scenario. But what about the problems a team might have to live and work with for days?
A hand wound that keeps getting wet, seasickness that makes eating difficult, or even a pressure sore aggravated by every rowing shift. Research into offshore sailing and ocean rowing shows why these less dramatic presentations deserve attention alongside preparation for serious emergencies.
Their significance depends partly on what life onboard allows… Rest may mean leaving someone else to cover a watch, and protecting an injury may be difficult in a cramped, wet environment, and reaching further care may require a change of course.
This is where ocean medicine asks clinicians to think beyond the immediate treatment and ask questions like:
How will the patient cope over the next few hours or days, what can the team realistically manage, and when should the plan change?
All sources and further reading available at the bottom of this article!
What medical problems occur at sea?
Ocean medicine can bring to mind dramatic rescues and severe exposure. However, published studies also describe wounds, musculoskeletal injuries, seasickness and skin problems.
A study of the Newport–Bermuda offshore yacht race, covering events between 1998 and 2006, recorded 38 injuries and 57 illnesses among an estimated 8,105 sailors. Lacerations were the most common injury type, while seasickness was the most common illness, but most reported problems could initially be managed onboard.
These findings describe a particular organised race rather than every offshore setting, but they do illustrate the value of preparing for common presentations.
Research published in 2023 into recreational offshore cruising found that smaller boats and less experience aboard the particular vessel being sailed were associated with more reported injuries. Most injuries occurred in favourable weather, a reminder that rough conditions are not the only circumstances in which people get hurt.
Medical preparation should therefore reflect the people, the vessel and the activity involved. Factoring in that an ocean rowing team will have different demands from passengers on an expedition ship or a crew undertaking a short coastal passage.
Why minor problems deserve early attention
A problem does not have to be immediately life-threatening to affect an offshore team.
Think about this: a painful hand wound may limit someone’s ability to handle equipment, persistent nausea may make it difficult to eat, drink or participate in normal duties. And a skin lesion may be repeatedly exposed to friction and moisture, making it difficult to protect during the activity that caused it.
Research examining medical communications during an ultraendurance ocean rowing race recorded 65 complaints, with 21 requiring input from race doctors. Dermatological problems accounted for 32% of complaints, including pressure sores and infections. Musculoskeletal problems accounted for a further 18%.
That study involved a specific sporting environment, so its figures should not be applied to all maritime activity. Nevertheless, it highlights a useful consideration for expedition healthcare: repeated physical demands and limited opportunities for recovery can make apparently manageable problems operationally significant.
An assessment needs to consider both the condition and what happens afterwards:
Can the person keep the affected area protected?
Can they rest?
Who will take over their duties?
When will they be reassessed?
A treatment plan that depends on keeping a dressing dry or avoiding repetitive movement needs to account for whether those instructions are achievable onboard.
Cold water shock and hypothermia are different hazards
Cold water can affect the body in several ways, and understanding the difference between cold water shock and hypothermia helps maritime teams prepare for what may happen during and after an immersion incident.
Cold water shock is the body’s immediate response to sudden immersion.
As the RNLI explains, it can cause an involuntary gasp, rapid breathing, and a sudden increase in heart rate and blood pressure. Someone who was breathing normally moments earlier may struggle to bring their breathing under control, increasing the risk of inhaling water and drowning. The RNLI highlights water below 15°C as a particular concern, although this should not be taken to mean that entering warmer water is without risk.
Hypothermia develops when the body’s core temperature falls below 35°C. It is different from the initial cold water shock response, but both can affect the same casualty. Recognising that distinction helps teams think beyond the first moments of an incident and prepare for the care someone may need once they are back onboard. The Wilderness Medical Society’s guidance on assessing and treating accidental hypothermia is included in the sources at the bottom of this article.
In practice, that preparation means having a clear plan for recovering someone without putting other people in danger, as well as somewhere suitable to assess them and provide shelter from the conditions. The equipment needed for their care should be accessible, and those helping should understand their roles and know how to use it.
Once the casualty is out of the water, the team still needs to assess their condition, provide appropriate care and decide whether further medical support or evacuation is needed. The Wilderness Medical Society’s 2024 drowning guidelines reflect this wider process, covering prevention and rescue through to resuscitation, ongoing clinical management and decisions about further care.
The vessel becomes part of the clinical assessment
On land, clinicians often work in spaces designed for patient care. At sea, the available space may dictate how that care is delivered.
A casualty might be on an exposed deck, in a narrow cabin or below a steep companionway. Moving them to a more suitable area could require coordination with crew who have different training and responsibilities.
Before settling on a treatment location, consider:
- Whether the casualty and those helping them can remain secure.
- Whether there is enough room for assessment and necessary interventions.
- How equipment will be reached and kept accessible.
- Whether the casualty can be moved along the proposed evacuation route.
- How changing conditions could affect continued care.
These are planning questions rather than a universal handling protocol, and the answers depend on the vessel, casualty, available personnel and conditions.
Vessel familiarisation helps turn an outline plan into something practical. Knowing that a stretcher is onboard is useful, but so is understanding where it is stored, who can help use it and whether it can pass through the spaces between the casualty and the transfer point.
Our Expedition Ship Medic Checklist, developed with Red Square Medical, includes reviewing ship layout and casualty evacuation pathways as part of preparation for a contract at sea.
Remote medical support needs a clear picture
Working offshore can involve substantial independence, but knowing when and how to seek advice remains essential.
The Maritime and Coastguard Agency explains that masters and skippers seeking UK telemedical advice should first contact HM Coastguard, which connects callers with a designated Telemedical Advice Service provider. This service supports medical care when illness or injury occurs at sea.
Useful communication requires more than naming the suspected diagnosis though. The person advising remotely also needs to understand the resources and circumstances surrounding the patient.
A structured handover should make clear:
- What has happened and how the patient’s condition is changing.
- Relevant clinical findings and observations.
- Treatment already given and the response.
- Available medicines, equipment and clinical skills.
- The vessel’s location and practical constraints on reaching further care.
MCA guidance emphasises having relevant information ready when seeking advice and provides a model medical report form, MSF 4155, to support communication. It also highlights the importance of familiarisation with the form and the procedures used onboard.
For clinicians joining a vessel, it helps to work through the support arrangements before departure, while there is time to clarify anything unfamiliar. This includes knowing who to contact for medical advice, how to reach them using the equipment onboard, and which backup options are available if the usual method fails.
Having those details agreed in advance means the team can focus on communicating the patient’s needs when support is required.
Evacuation planning starts before deterioration
Requesting help is one part of an evacuation, but the team also needs to understand what could happen between making that call and the casualty reaching further care. Depending on the vessel’s location and the conditions, there may be a period of waiting, during which treatment and monitoring will need to continue onboard.
Before departure, it is worth working through the evacuation arrangements with the people responsible for putting them into action. This includes identifying the support available, checking how a casualty could be moved from different parts of the vessel, and considering what the team could manage if a transfer were delayed. Our Expedition Ship Medic Checklist made with the help of Red Square Medical covers this preparation, including reviewing medevac plans and available emergency assets.
During an incident, the clinical picture and the practical options need to be discussed together. The medic can explain how the patient is responding to treatment, any concerns about deterioration and the care they are likely to need. The skipper and relevant maritime services can then assess those needs alongside the vessel’s position, conditions and transfer options.
Agreeing when to seek additional advice, and recognising when a patient’s needs may exceed what can safely be provided onboard, gives the team a clearer basis for making decisions. It also helps to consider alternative arrangements in advance, so that a change in weather, communications or available support does not leave everyone relying on a plan that can no longer be carried out.
Every case will be different, but working through the practical details before sailing gives the team a shared understanding of the options available and where further support may be needed.
Developing clinical judgement for ocean environments
Preparing for medical care at sea means bringing clinical knowledge together with an understanding of the environment in which it will be used.
That includes recognising immersion hazards, managing common problems early, communicating effectively with remote support and developing plans that account for the vessel and available crew.
It also means practising those decisions. Working through a scenario on the water gives teams an opportunity to examine how casualty access, vessel movement and communication affect their approach.
If this is an area you would like to explore, our Ocean Medicine course combines teaching, practical workshops and on-water scenarios in Brixham. Its content includes immersion physiology, cold water shock, hypothermia, casualty handling, trauma in restricted environments, communications and evacuation considerations.
For clinicians interested in working on or around the water, these are opportunities to explore how existing skills translate into a setting where the environment influences every stage of patient care.
Sources and further reading
If you’d like to explore the research and guidance behind this article, these are useful places to start:
- Injury and Illness at the Newport–Bermuda Race 1998–2006
Published in Wilderness & Environmental Medicine in 2008, this study looked at injuries and illnesses reported across five offshore yacht races, including wounds and seasickness. - Injuries and Health Issues Occurring During Offshore Transoceanic Sailing
This 2023 study explores the experiences of recreational offshore sailors and cruisers, including how boat size and familiarity with the vessel were associated with reported injuries. - Common health issues and advised treatments reported in an ultraendurance ocean rowing race
Published in BMJ Open Sport & Exercise Medicine in 2022, this paper examines medical complaints during an ocean rowing race. It offers useful insight into skin problems, musculoskeletal injuries and seasickness in this demanding setting. - RNLI guidance on cold water shock
An accessible explanation of how sudden cold water immersion affects the body, why it can be dangerous and how to reduce the risks. - Wilderness Medical Society guidelines on accidental hypothermia
The society’s 2019 update provides clinical guidance on assessing and treating accidental hypothermia outside hospital. - Wilderness Medical Society guidelines on drowning
Updated in 2024, these guidelines review the evidence around drowning prevention, rescue, resuscitation and subsequent medical care. - Maritime and Coastguard Agency guidance on getting medical advice at sea
Official guidance explaining how masters and skippers can access the UK’s Telemedical Advice Service through HM Coastguard. - Maritime and Coastguard Agency guidance on medical care onboard
Sections 8 and 9 are particularly relevant to this article, covering telemedical advice and the information to have ready when seeking help. - Our Expedition Ship Medic Checklist
Developed with Red Square Medical, this practical resource covers preparation for a ship medic contract, from checking medical supplies to understanding evacuation arrangements. - Our Ocean Medicine course
For those interested in developing their skills further, the course page outlines the teaching and practical training available in Brixham.
Clinical note: This article provides an educational overview for healthcare professionals. Assessment and treatment should follow current guidance, the event medical plan, local protocols and the clinician’s scope of practice.