I usually steer clear of addressing medical issues as it is too close to the day job but it is an obvious omission from this Forum thus far. It occurred to me that amongst our members we, collectively, must have vast experience of the medical issues a cruiser might confront in the course of their sailing lives. I am certainly aware of some very challenging problems that have arisen on board member 's vessels in recent years. The aim of this thread is to get people thinking about the unthinkable and reflect on how things might have been done better. Who knows it might even save a life one day?

So my first case report is an account drawn from my knowledge of what happened to a member during her OCC qualifying passage. It may not be entirely accurate as this is obviously written third hand but it raises many issues worthy of comment.

On passage from Las Palmas to St Lucia a 40 ' yacht with a paying crew of 4 and a professional skipper were a 1,000 miles from Rodney Bay when one of the crew, a male in his late 60 's, suddenly died at the saloon table. There was no warning, no symptoms. One moment he was alive the next moment he was dead. A retired doctor was on board who led a fruitless attempt at resuscitation. What is not taught in first aid courses is that the success rate of a resuscitation attempted in the community is in the region of 5%. It 's how quickly to being defibrillated that really makes the difference and even in the best equipped centres the success rate is not much more than 50%. Though my figures might be out of date they do give an idea that the odds of successfully reviving someone in cardiac arrest mid ocean are poor. If the resuscitation had been successful then how would that crew have coped with a critically ill patient who would have presented a challenge to any fully equipped coronary care unit or ITU? Should a charter yacht taking ageing clients across an ocean carry a defibrillator and train their skippers to use them. I think not but it is worthy of debate.

Anyway the man was dead and the latitude was about 17 degrees north with 1,000 miles to a safe haven. The boat was making about 130 miles a day but the wind was declining and they only had enough fuel to motor for 2 days. For some reason (I am not sure why) the SSB couldn 't be coaxed into action but fortunately the OCC member had borrowed an Iridium phone and a mini solar charger so that she could ring home from time to time. The call was made to Falmouth and the advice received was to keep the corpse on board and continue towards St Lucia. Was that good advice? Hot climates and decomposing corpses are not a good combination and the risk of infection to the survivors is very significant. Again comment very welcome.

Charter boats crossing oceans apparently carry body bags and this was no exception. The trouble is the bag was too small to be sealed so the crew tried their best to use other plastic bags to wrap the remains before placing them in the forepeak and duck taping around the doors in an attempt to seal off that part of the boat. I don 't want to be too gruesome but this did not work and of course the bilge drained the forepeak so the boat soon became a floating hazard to health. Meanwhile the ARC controllers coordinated other boats to standby and supply fuel in case of calms. The boat forged on and made reasonably good time to St Lucia where it was immediately quarantined and the traumatised crew were brilliantly supported by the ARC organisers.

A sad tale of a probably unique qualifying passage but it does for me raise all manner of questions and I would be grateful for comment not least because we will soon be sailing over the horizon and want to prepare, but not over prepare, for the worst that might happen. So here are some suggestions for discussion.

Should we all carry defibrillators and insist that everyone is trained to use them?
If we are all going to be equipped for advanced life support then how are we going to care for that critically ill survivor for the following week and what additional kit should we carry?
I am reminded of our first Atlantic passage when a cruising couple sought advice from Falmouth for the husband who had had a heart attack mid ocean. A cargo ship was diverted and an attempt made to transfer the critically ill gent from yacht to ship in rolling seas. Thankfully the attempt was quickly abandoned and he survived on board his own yacht with the help of a nurse and some additional crew scavenged from yachts in the vicinity. My guess is that the advice issued came from some medical registrar on call who hadn 't any idea of the consequences of his advice. So should common sense have prevailed over 'official advice '?
Again should official advice have been ignored and the body disposed of at sea in a dignified fashion? Would that have been the safest option? Should we be writing down such advanced directives when we put to sea in good health to make it simpler for those left behind?
If they had disposed of the body what would have been the legal consequences of ignoring Falmouth and should the relatives back home have contributed to that decision to sail on? Were they even consulted?
Should we all be carrying bomb proof-ways to communicate across the water or should we stay in blissful isolation and just get on and do what ever needs to be done? I think there is no question that skipper
There is no doubt that skippered charter yachts must have very robust and reliable communications that must work and the skills must be on board to use them. However should all us amateurs be similarly equipped.
What would you have done differently and why?
Should the OCC provide a panel willing to advise in such situations to avoid crass rescue attempts etc?

If there is interest in this thread I will, from time to time, post similar case stories for comment but would very much welcome contributions from any member with their own first hand experiences.

Simon

The only reason for calling to Falmouth is if you are about to step UP into your liferaft.
Once out on the ocean, you must rely on your own experience and common sense, with possible help from nearby yachtsmen.
Julia and I were on the '99 crossing and heard the complete story on the SSB of how two crew plus a nurse were transferred to the casualty, the nurse assessed the patient and called for advice, a sailing doctor 500 miles away prescribed treatment, a further yacht transferred the necessary drugs, the hospital in St Lucia could not cope with the seriousness so he was flown to Martinique where a leading French heart specialist just happened to be on holiday...three months later the patient was drinking gin in our cockpit...a most fantastic story of co-operation and sheer common sense from fellow yachtsmen.
My family have always known that if the worst happened, I would not return and they would assume that I was enjoying myself with the mermaids.
When Julia and I were preparing for our first long passage together, I made the point forcefully to her children that should she die at sea, I would give her the smartest burial I could and they would have to trust me...I do not care a damn for officialdom and their rules. However, in view of the questioning expected, I would have made for the nearest British Consulate downwind where I could have explained in my own language, though I do think that Frances 's idea of saying they fell overboard has merit!