From the Bridge

Lucy Chabot Reed

You are walking out of a restaurant in Antigua and a gentleman in front of you collapses on the sidewalk. Are you prepared for the medical emergency at your feet?

Many captains are, thanks to licensing requirements that include some first aid proficiency. But the extras that could mean life or death on a remote Caribbean island or out at sea are more than worth the expense, according to this month’s Bridge captains.

On the suggestion of a captain in his 60s with a boss of the same age, The Triton’s monthly captains’ roundtable discussed medical emergencies and how yachts are prepared for the occasion when the boss, a guest or a crew member gets ill or injured in a place with limited or questionable medical services. Do most yachts run with standing orders for such things as a medical evacuation?

As always, individual comments are not attributed to any one person in particular so as to encourage frank and open discussion. The attending captains are identified in the above photograph.

“We’re getting ready to sign on with MedLink,” one captain said. “They’ll come on board and train you. The previous owner had it. We’re private, not charter, so we don’t have a lot of the issues other boats have.”

“I’ve been looking into getting a defibrillator,” another captain said. “We’ve all been trained and we have a lot of equipment on board” including oxygen and a comprehensive first-aid kit.

“That’s the first line of defense isn’t it?” a third said. “We need to make sure we all keep our certifications up to date.”

“And have a second line of communication,” replied another. “The whole system of MedLink works around communication. Communication is key to an emergency, especially for someone who’s not a doctor.”

All the captains agreed that back-up communication was necessary, including a satellite phone, a back-up sat phone, cell phones, single-side band and VHF radios.

“We have a very clear plan on board,” one captain said. “We have a defibrillator and the AED people train us once a year with new techniques. We’re all trained at the same time, so we know what each person has to do. We have two people who are fully trained so that if one of them is the injured person, there’s someone to work on them.

“And we carry a lot of oxygen,” he said. “Oxygen will keep you alive. If you give them [an injured person] oxygen and CPR, their chances are pretty good.”

This captain noted that his yacht carries three medical kits, much like the old-fashion doctor’s bags, in different parts of the boat. Each contains pretty much the same items, with one that carries medicines such as morphine.

Another captain who worked with an owner who drank a lot and often fell while on board also equipped his boat with several medical kits.

“We got an Inmarsat C on board, because that’s the only thing we had then,” he said. “That owner knew he needed to take precautions because he liked to drink and because he liked to go to isolated places. My current owner is coastwise so he’s not too concerned about it. We have a sat phone and the coast guard is never too far away.”

He described the owner as conservative and, because of the limited risks associated with his style of cruising, won’t spend the money to sign up for something like MedLink.

“The master can be absolved of the safety of the owner, but nothing can absolve him of the safety of the crew,” another captain said. “Flag states require some medical training. Someone on the boat has to have it, not necessarily the captain. So we do the drills, and we play the ‘what if’ game all the time. If I fall down the steps, what happens? We’re launching the tender and I’ll say what happens if a strap breaks?”

“My situation is a little different,” one captain said. “I’m a single captain with a pick-up crew. I’m privately owned and the owner doesn’t want a lot of crew running around. I hire temporary crew for deliveries and I’ll pick up a chef/stew for some longer trips, so we don’t have much time to work together.

“If something happens to him or his wife, and I get him stabilized, my feeling is he wants a jet there with a flight doctor,” he said. “That’s what would happen in his corporate life. That’s what should happen when we’re out at sea.”

No one had a separate flight plan established with an evacuation company, and several captains noted that sometimes the yacht’s insurance policy will cover medical evacuations. Also, some international health insurance plans offer it, and one captain noted that platinum-level American Express card offers it.

While several captains said they know everything they need to know about their boss’ medical conditions, others said they don’t. Is this something a captain should know, and if so, how do you go about asking about it?

“We use a closed envelop,” one captain said. “We ask everybody who comes on board that if something happens, what do we need to know? Most have been forthright with the information and say, ‘thanks for asking. Here’s my doctor’s name and phone number.’”

“Something as easy as a bee sting, a guest could die,” one captain noted.

“My boss is 82,” another said. “I know his medical needs. He likes his airplane, so when we go someplace, the plane sits nearby. We can call the pilot and he’ll be there in an hour.”

There was some discussion about what the yacht and captain’s responsibilities are to the crew and all agreed that whatever conditions are expected for the owner – in terms of equipment, treatment or evacuation – would apply to any crew member as well. And then, the captains talked about themselves.

“I have to say that I’ve often thought when we go to the Caribbean, what would happen if I get hurt?” one captain said. “It would be nice to have an extra hand. Yes, the mate can handle the boat, but then we’re one man down.”

“We do the same thing, we take on an extra guy,” another said. “It’s worth it.”

“You have to ask yourself, how many people does it take to handle an emergency?” a third captain said. “I say at least three: one to communicate, one to handle the boat and at least one to handle the emergency.”

One captain who works solo often moves the boat great distances alone. Several captains thought that approach was unnecessarily risky.

“If it’s just me on a delivery and I get hurt, I can handle that,” the solo captain said. “If it’s someone else who gets hurt or killed, I don’t want to ask someone to do that.”

“What if you fall down and break a leg?” a captain said. “You can’t even get to a radio and you’re still running at 20 knots.”

“As a professional, you have got to have watch and by definition that means more than one person,” another said. “My biggest fear is your foot gets tangled in a line and you fall overboard. The boat’s going away and I’m in the water. That’s my biggest fear.”

There was a lot of discussion about assessing the risks on a particular yacht, a particular journey or with a particular contingent of guests. The higher the risk, these captains agreed, the more precautions they would take from an emergency standpoint.

“You have to make a risk assessment,” a captain said. “My crew and the boss’ family are all the same. We operate in pretty narrow parameters of risk. We have a back-up airplane, but I still think it’s a good idea to have a defibrillator.”

“I want oxygen and a defibrillator onboard,” another said, “but the owner said, ‘I’m healthy, what do I need that for?’ I told him it wasn’t for him, it was for me and he said OK.”

For owners who don’t want more crew or equipment, one captain suggested engaging in a little self preservation.

“Take some action,” he said. “Research and recommend something to the boss, then if he doesn’t buy it or hire the service, write that down. That way you aren’t solely responsible or liable if something goes wrong.”

“And it’s important to know what your options are in getting someone somewhere,” another captain said, recalling the incident a few years ago in the Caribbean of a teenager on a jet ski who ran over another child.

The injured child was shipped to one hospital then another in places like Guadalupe before he finally died, the captain said.

If they had had something in place or knew where to go, that might not have happened, he said.

“With my background, we always relied on the coast guard,” another said. “If I ever have a problem, they’d be the first one I’d call.”

Each month, The Triton invites yacht captains to lunch to discuss industry issues and trends. To share some knowledge regarding this topic, e-mail Editor Lucy Reed at lucy@the-triton.com. If you are a hired yacht captain and find yourself in Ft. Lauderdale on July 5 or Maine on Aug. 2, e-mail Triton Editor Lucy Chabot Reed at lucy@the-triton.com for an invitation.Come be part of the conversation and meet your peers.Space is limited to eight.

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