4.8 First Aid, Survival & Cold-Water Immersion

First Aid, Survival, and Cold-Water Immersion

The OUPV license requires current CPR and first-aid certification because at sea you are the first responder - help is minutes to hours away. This section is a working overview and does not replace hands-on certification.

CPR, AED, and choking

For an unresponsive adult who is not breathing, start CPR: 30 chest compressions to 2 rescue breaths, compressions at least 2 inches deep at 100-120 per minute, allowing full chest recoil between pushes. Use an AED as soon as one is available - power it on and follow the voice prompts, and dry the chest first on a wet or immersion victim so the pads adhere and the shock is not shorted across the skin. For a conscious choking adult, give abdominal thrusts (the Heimlich) until the object clears; if they go unconscious, begin CPR.

Bleeding and shock

Control serious bleeding with firm direct pressure using a clean dressing; add more dressings on top rather than lifting a soaked one, and keep pressure on. For life-threatening limb bleeding that pressure will not stop, apply a tourniquet above the wound and note the time. Shock - pale, cool, clammy skin, rapid weak pulse, confusion - follows serious injury or blood loss: lay the person down, keep them warm, elevate the legs if there is no head, chest, or spinal injury, and monitor breathing.

Hypothermia and the 1-10-1 principle

Hypothermia - dangerously low core temperature - is the offshore killer. It runs from mild (shivering, still alert) through moderate (shivering stops, confusion, slurred speech, clumsiness) to severe (unconscious, rigid, barely detectable pulse). Handle a severely hypothermic person gently - rough movement can trigger cardiac arrest - remove wet clothing, insulate, and rewarm gradually. Do not give alcohol or rub the extremities.

The 1-10-1 principle describes falling into cold water and tells you where to spend effort:

• 1 minute - cold shock. The initial gasp and uncontrolled hyperventilation are the greatest drowning danger; do not panic, keep your head above water, and get your breathing under control.
• 10 minutes - cold incapacitation. You have roughly 10 minutes of meaningful movement before your hands and arms stop working; use it to self-rescue - get out of the water or into a position that keeps your airway clear.
• 1 hour - hypothermia. It takes about an hour before you become unconscious from hypothermia, so rescue is realistic - do not give up.

The surprise for most people: the majority of cold-water deaths are drowning during that first minute of cold shock, not hypothermia an hour later - which is exactly why a PFD, keeping your airway up while you regain control of your breathing, is the difference between living and dying.

In-water survival tactics

If you cannot get out of the water: stay with the boat (a bigger target that may still float) and do not swim unless safety is very close - swimming increases heat loss by roughly a third to a half. Wearing a PFD, adopt the HELP position (Heat Escape Lessening Posture) - draw your knees to your chest and hug your arms in to protect the high-heat-loss groin, armpits, and chest. With two or more people, huddle together, chests in, to share warmth and stay together for searchers.

Drowning and near-drowning

For a near-drowning victim the priority is the airway and breathing - start rescue breaths as soon as it is safe, and begin CPR if there is no breathing. Because cold water slows the body's oxygen demand, prolonged resuscitation is worthwhile - the maxim is "no one is dead until warm and dead." Treat every rescued immersion victim for hypothermia and watch even a recovered person for delayed breathing trouble.

Heat illness

The water is not always cold. Sun and heat cause heat exhaustion - heavy sweating, weakness, nausea, cool clammy skin - treated by moving the person to shade, cooling them, and giving fluids. If it worsens to heat stroke - hot skin, altered mental status, very high temperature - it is a medical emergency: cool aggressively (shade, wet the skin, fan) and get help. Prevent both with shade, water, and rest; glare off the water dehydrates passengers faster than they expect.

Seasickness

Seasickness causes misery, dehydration, and a distracted, unsteady passenger at risk of falling overboard. Prevention beats cure: fresh air, eyes on the horizon, stay amidships where motion is least, avoid heavy greasy food and alcohol, and take medication (meclizine, a scopolamine patch, or ginger) before getting underway. Keep the sufferer hydrated, seated low and secure, and inside the rails - never let a seasick person hang over the side unattended.

The ship's medical kit

Carry a stocked first-aid kit, know how to use it, and ask passengers about medical conditions and allergies before departure. Keep your CPR/first-aid certification current and carry a means to call for help (VHF/DSC). On the exam the high-yield facts are 30:2 CPR, direct pressure for bleeding, 1-10-1 (control breathing, self-rescue, then about an hour to hypothermia), HELP/huddle and stay with the boat, and prevent seasickness before it starts.