Science & Sports (2011) 26, 174—178

BRIEF NOTE

Emergency preparedness and long-distance leisurecatamaran sailingSoins médicaux d’urgence et croisière en catamaran sur longue distance

T.J. Lugera,∗, D. Pehamb, B. Mayrc, G. Grömerc, H. Raaba, M.F. Lugera

a Department of Anaesthesiology and Critical Care Medicine, Innsbruck Medical University, Innsbruck, Austriab Department of Psychology, University of Innsbruck, Innsbruck, Austriac Austria Space Forum, University of Innsbruck, Innsbruck, Austria

Received 6 August 2010; accepted 9 December 2010Available online 15 March 2011

KEYWORDSSailing;Injury;Illness;Medicalpreparedness;Atlantic

SummaryIntroduction. — This prospective study aimed to provide insight into the incidents sustained bycrewmembers and the medical briefing (e.g. medical history, vaccination) preceding transat-lantic catamaran sailing.Synthesis of the facts. — Medical treatment for 24 mainly minor incidents and 10 check-up inter-ventions were recorded. Injuries (4.5/1000 h) were incurred largely by stumbles (lacerations,contusion, haematoma) and cooking (burns). The most common illnesses (5.8/1000 h) wereseasickness, sunburn and dietary disorders. Incidents were significantly dependent on sailingconditions.Conclusions. — Medical preparedness for long-distance leisure sailing requires knowledge ofcharacteristic incidents in order to create safety policies and educate crewmembers and thusreduce risk.© 2010 Elsevier Masson SAS. All rights reserved.

MOTS CLÉSNavigation ;

RésuméIntroduction. — La présente étude prospective avait pour objectif d’identifier les incidentsmédicaux survenus en mer et de présenter la préparation médicale des membres de l’équipage.Synthèse des faits. — Le traitement médical de 24 incidents a été rapporté. Les blessures

Blessures ;

Maladies ; (4,5/1000 heures) ont été occasionnées en majeure partie par des trébuchements. Parmi lesmaladies (5,8/1000 heures) figurent avant tout le mal de mer et les coups de soleil. Ces incidentsdépendaient des conditions de navigation.

Abbreviations: Bf, Beaufort; NACA, National Advisory Committee on Aeronautics; GPS, Global positioning system; nm, Nautical miles;kn, Knots.

∗ Corresponding author.E-mail address: thomas.luger@i-med.ac.at (T.J. Luger).

0765-1597/$ – see front matter © 2010 Elsevier Masson SAS. All rights reserved.doi:10.1016/j.scispo.2010.12.008

Préparationmédicale ;Atlantique

Conclusion. — L’objectif de la phase préparatoire est de mettre en place des mesures de sécuritévisant à réduire au mieux le risque médical pour les membres de l’équipage.© 2010 Elsevier Masson SAS. Tous droits réservés.

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1. Introduction

Long-distance sailing, whether monohull or catamaran, isan up-and-coming form of recreation and crossing theocean under sail is becoming increasingly interesting asan adventurous challenge. According to reports on emer-gency situations encountered mostly in professional yachtraces, athletes suffer injuries including sprains, lacerations,contusions, fractures and splinters mainly caused by dolor-ous contact with the boom, by stumbling on ship and byjumping onto the landing-stage [1]. Upper respiratory tractinfection, seasickness, sunburn and hypertension are theillnesses reported in healthy sailors [2]. In fact, emergen-cies and illnesses are described predominantly in sailors ondifferent kinds of yachts, making it all the more interest-ing to investigate these during leisure catamaran sailing.Thus, the purpose of the present study was to document theinjuries and illnesses sustained by a sailing crew under long-distance sailing conditions and to provide an insight into thefrequency and severity of such incidents and into medicalpreparedness.

2. Subjects and methods

2.1. Subjects

After approval by the Ethics Committee of InnsbruckMedical University (UN3004; 12.09.2007), 11 recreationalsailors (male:female = 9:2; age: 43.2 ± 10.3 years; BMI:26.1 ± 5.4 kg/m2; good cardiorespiratory health) signedwritten informed consent. All were familiar with sailingand had experience with one-week offshore cruises, long-distance regattas and sailing in sometimes choppy water,three were officials in a yachting club and organized nationalsailing regattas, 10 had a license for offshore sailing.Pre-existing diseases were one chronic ear infection andoverweight in five sailors, two of whom also had hyperlipi-demia and hypercholesterinemia and were under medicaltreatment for mild arterial hypertension. Exclusion criteriawere a history of cardiovascular or pulmonary disease or arespiratory infection in the two weeks prior to the study.

2.2. Cruise description

The seven-week cruise on a catamaran Lagoon 440, modelyear 2007, was divided into three legs, each undertaken witha different crew. The first leg (A) from La Rochelle, France,

to Cascais, Portugal was sailed by five crewmembers and thesecond leg (B) from Cascais to Tenerife by seven sailors. Thelast leg (C) was sailed by six sailors from Vera Cruz in Tener-ife, Spain, to Guadeloupe in the Caribbean. For navigation a

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armin® eTrex global positioning system was used, and theailing conditions were described (Table 1). We observed noailing condition > 9 Beaufort (Bf). Boat speeds were up tomaximum of 14.5 kn. Weather conditions were cloudy to

eavily overcast (leg A) or sunny to cloudy (legs B and C).utdoor temperature in La Rochelle was up to 12 ◦C (night◦C) with a relative outdoor humidity of 62%, climbing to up

o 31 ◦C in Guadeloupe (night 20 ◦C) with a relative humidityf 79%. Six days before the Antilles heavy rain and lightningccurred.

.3. Medical preparedness

ore than two years were invested in medical briefing:

online searches using the terms ‘‘sailing’’ and‘‘medicine’’ in Pubmed (162 articles);medical assessment of degree of seaworthiness and med-ical history;update of vaccination certificate;medical equipment and medication. On the open sea theavailability of medical assistance is dictated by distanceand the environment. For this reason our goal was to beable to successfully deal with a medical problem at sea forat least three days in order to give the patient sufficientprehospital medical treatment or the chance to survivein this special sailing environment. With this in mind weselected appropriate medication and medical hardware;provide advance medical information on personal safetyand possible incidents. This included discussing disastersituations including death.

.4. Data analysis

ncidents and medical treatment were noted on a medicaleport sheet. The specific sailing variables were evaluatedn a four-hourly basis using a sailing report sheet. Incidenceas calculated as ‘‘total number of injuries or illnesses/1000

ailing hours’’ (n/1000 h). We analysed data using SPSS soft-are (Version 12.0.1) as mean ± S.D. On a four-hourly basiscomparison of the sailing conditions at the time of an inci-ent versus non-incident was calculated. Mann-Whitney Uest: P value ≤ 0.05.

. Results

Medical preparedness, emergency care and sailing 175

uring transatlantic sailing 24 mainly minor incidents and 10heck-up interventions requiring the physician’s attentionere recorded (Table 1). On leg A, one sailor complained of

easickness. On leg B, four sailors had at least one illness or

176T.J.

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Table 1 Incidence and cruise description for each leg and the whole cruise.

Leg A Leg B Leg C Whole cruise

Incidents 1 (0/1/0) 8 (4/4/0) 15 (6/8/1) 24 (10/13/1)Incidents/1000 h 1.7 (0/1.7/0) 9.4 (4.7/4.7/0) 5.3 (2.1/2.8/0.4) 5.6 (2.3/3.1/0.2)Incidents/sailor 0.2 (0/0.2/0) 1.2 (0.6/0.6/0) 2.5 (1/1.3/0.2) 2.2 (0.9/1.2/0.1)

Sailing hours (h) 121 121 475 717Distance travelled (nm) 738.4 700.0 3209.3 4647.7

Under sail (nm [%]) 708 [95.9] 391.8 [56] 2009.6. [61] 3109.4 [66.1]Daily distance (nm) 134.3 ± 27.9 138.8 ± 18.6 162.2 ± 26.3 147.0 ± 37.2Incident vs. no incident 127.0 vs. 122.9 ± 26.7 129.1 ± 47.5 vs. 110.4 ± 47.0a 174.1 ± 17.7 vs. 151.4 ± 35.3a 157.2 ± 37.1 vs. 139.2 ± 39.0a

Wind velocity (kn) 20.5 ± 4.5 15.5 ± 9.2 17.8 ± 7.3 17.8 ± 7.3Incident vs. no incident 24.0 vs. 20.3 ± 4.2 18.5 ± 8.8 vs. 14.0 ± 8.4 21.5 ± 6.5 vs. 16.9 ± 7.1a 20.6 ± 7.1 vs. 17.2 ± 7.0a

Beaufort classification 5.0 ± 1.3 3.2 ± 2.3 3.9 ± 1.9 3.9 ± 2.0Incident vs. no incident 6.0 vs. 5.0 ± 1.2 4.1 ± 2.2 vs. 2.7 ± 2.0 4.9 ± 1.8 vs. 3.6 ± 1.8a 4.7 ± 1.9 vs. 3.8 ± 1.9a

Sea 2.7 ± 0.5 2.0 ± 1.9 1.9 ± 1.6 2.1 ± 1.5Incident vs. no incident 3.0 vs. 2.7 ± 0.5 2.6 ± 1.9 vs. 1.7 ± 1.6 2.9 ± 1.6 vs. 1.7 ± 1.4a 2.8 ± 1.6 vs. 1.9 ± 1.4a

Boat speed (kn) 7.7 ± 1.4 7.3 ± 1.6 7.2 ± 1.1 7.2 ± 1.2Incident vs. no incident 7.5 vs. 7.7 ± 1.3 7.7 ± 1.4 vs. 6.9 ± 1.5 7.3 ± 0.7 vs. 7.1 ± 1.1 7.5 ± 0.9 vs. 7.2 ± 1.2

Values are incident (injury/illness/complication), distance travelled (nm), wind velocity (knots), time (hours), Beaufort classification (0 to 12 Bf) and sea (0 = calm to 4 = rough).Mean ± standard deviation or number. Comparison of sailing conditions at the time of an incident versus non-incident.

a Mann-Whitney U test, significance = P ≤ 0.05

Medical preparedness, emergency care and sailing 177

Table 2 Incidents and severity: incidents, mechanisms of injury, illness and complication (secondary bleeding of the skin ofthe heel) as well as incidents as a function of crew jobs.

Incidents Severity

Incidents (%) Per sailor Per 1000 h NACA I/II/III Sailing days absent (average/incident)

IncidentsInjurya,b 10 (41.6) 0.9 2.3 3/6/1 0Illnessc-f 13 (54.2) 1.2 3.1 11/2/0 1 (0.08)Complication 1 (4.2) 0.1 0.2 0/1/0 0Check-up interventions 10 2.2 5.6 14/9/1 1 (0.04)

Mechanisms of incidentsInjury

Stumblea 4 (16.7) 0.36 2.0 2/2/0 0Impacta 2 (8.3) 0.18 2.7 1/1/0 0Cookingb 4 (16.7) 0.36 2.9 0/3/1 0

IllnessSeasicknessc—e 5 (20.8) 0.45 3.4 5/0/0 0Sunburn 3 (12.5) 0.27 2.7 2/1/0 0Dietary 3 (12.5) 0.27 2.7 2/1/0 1 (0.33)Divingf 2 (8.3) 0.18 2.7 2/0/0 0

ComplicationBleeding 1 (4.2) 0.09 1.4 0/1/0 0

Incidents as function of crew jobInjury

Skippera 4 (16.7) 0,36 5.4 1/2/1 0Navigator 1 (4.2) 0.09 1.3 1/0/0 0Grindera 2 (8.3) 0.18 3.2 1/1/0 0Cookb 3 (12.5) 0.27 9.7 0/3/0 0

IllnessNavigatord 1 (4.2) 0.09 1.6 1/0/0 0Grinder 1 (4.2) 0.09 1.6 1/0/0 0Cook 2 (8.3) 0.18 4.0 1/1/0 0Choresf 2 (8.3) 0.18 2.7 2/0/0 0Sailorc,e 7 (29.2) 0.63 18.8 5/2/0 1 (0.14)

ComplicationSkipper 1 (4.2) 0.5 1.3 0/1/0 0

Values are numbers (%), incidents/sailor and incidents/1000 sailing hours.All incidents were incurred on leg C with the exception of aone contusion on Leg B, btwo lacerations on leg B, cone case of seasickness

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on leg A as well as done and etwo on leg B and fone case of otitiimpact from boat hardware; diving: ear infection from a pre-exist

injury. On leg C, five sailors reported incidents and neededcheck-up interventions. During the cruise as a whole and onlegs C, the sea, Bf, sailing distance and wind velocity wererated significantly higher at the time of an incident. Thehighest overall incidence of medical intervention was seenin persons performing cooking duties and in off-duty sailors.

Details of injuries and illnesses and their severity arepresented in Table 2. The main injury mechanisms (63.6%rated NACA II) were stumbling on board or impacts withboat hardware, causing lacerations (8.2/1000 h), contu-sions and haematomas (7.2/1000 h) of the upper andlower limbs. Sailors performing cooking duties had thehighest overall injury incidence, like second degree burnof the hand (1.4/1000 h). All injuries were sufficiently

treated with disinfectants, compression bandages and localtherapy as appropriate. Only one complication occurred(1.4/1000 h). The predominant illness diagnosis (75% ratedNACA I) was seasickness (16.9/1000 h), followed by sunburn

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ia on leg B. No crewmember showed NACA 4 or higher. Impact:isorder; grinder: helmsman and grinders

2.0/1000 h), eye irritations (3.6/1000 h), ear infections2.7/1000 h) and dietary disorders (5.2/1000 h), the lat-er were responsible for absence of sailors from sailing.edical treatment was administered orally in the form ofntiemetics and medication for diarrhoea, or locally appliedortisone ointment. Diet was recommended when necessary.on-steroidal anti-inflammatory drugs were used for painherapy in combination with gastric protection.

. Discussion

njuries (4.5/1000 h) were mainly caused by stumbles (lac-rations, contusion and haematoma of the upper and lower

imbs) and cooking activities (burns). Injury incidence, con-istent with those reported previously [1], is an importantactor that may directly affect the sailors on duty during theime a crewmember is not able to observe his sailing duties.

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ur incident severity was low and all injuries were able toe treated on board. In this study, the skippers and the cookere at greater risk for injury, which may be attributed to

he high intensity of cooking (burn) and sailing (contusion)ctivities. Illnesses (5.8/1000 h) were seasickness, sunburnnd dietary disorders. All injuries or illnesses presented herean be specific to catamaran sailing. However, the kindsf yacht used in competitions or even leisure sailing differignificantly from ours (monohulls versus catamaran), theemands made of our sailors were very different, and this iseflected in their injury and illness epidemiology. The litera-ure contains only few publications on catamaran sailing [3].dditionally, the power of our study design is not as strongs for studies conducted during competitions [4]. Despitehese limitations the potential for severe injury or illness atea should be kept clearly in mind.

In long-distance leisure ocean sailing appropriate atten-ion should be given to the crew’s health, including advanceedical assessment, information programs and manage-ent of therapeutic resources. Also to be addressed are

he characteristic problems involved in medical diagnosisnd treatment at sea over a longer time with no immedi-te possibility for aid. Thus, reserve medical supplies areecommended for long sea voyages. The profession of theerson in charge of first aid dictates the medical equipmenteeded for the cruise so as to be able to cope with life-hreatening situations and render proper first aid (first aidits and checklists). Furthermore, an ocean crossing underail requires that supplies on hand be sufficient to provideedical assistance over a longer period. Another important

spect of medical preparedness is for each person to pro-ect himself against injury, e.g. by wearing a life jacket, ory handling the gas stove carefully [1]. One factor that cer-ainly contributed to our low incidence and minor severity

[

T.J. Luger et al.

f incidents was the sound medical preparedness of allrewmembers. In practice, medical preparedness for long-istance leisure sailing requires knowledge of characteristicnjuries and illnesses in order to create safety policies andducate crewmembers with a view to reducing the risk fornjury and illness.

onflict of interest statement

one.

cknowledgements

e wish to thank the other eight crewmembers of theransatlantic Challenge 2007 (TAC 07), namely Christina,ilvia, Martin 1, Martin 2, Klaus, Christian, Peter, and espe-ially Skipper Walter for their cooperation. We are alsondebted to Harald Mayr, Fairrescue International, Mayr &aller KEG, Innsbruck, Austria, for support with regard toedical devices.

eferences

1] Allen JB, De Jong MR. Sailing and sports medicine: a literaturereview. Br J Sports Med 2006;40:587—93.

2] Luger TJ, Giner R, Lorenz IH. Cardiological monitoring of sailorsvia offshore Internet connection. J Sports Med Phys Fitness2001;41:486—90.

3] Grainger R. Some aspects of the safety of high speed catama-

rans. Bull Inst Marit Trop Med Gdynia 1996;47:61—6.

4] Neville VJ, Molloy J, Brooks JHM, Speedy DB, Atkinson G.Epidemiology of injuries and illnesses in America’s Cup yachtracing. Br J Sports Med 2006;40:304—12.