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Storms on the High Seas: Healthcare and Managing Risk on a Sailing Circumnavigation

Bryony Palmer, RN, from Instagram’s @cutterbove_sailing_

My husband and I are undertaking a circumnavigation on our 41ft, steel sailboat named Rhythm. This venture is showing itself to be a platform for practicing and understanding the unique ways in which sailing, wilderness medicine, and risk assessments intersect, with heavy weather sailing lending itself well to these topics.

The wind and the waves.

Advice recommends not putting a vessel through waves over 30%-60% its waterline length in size, which for us means >12.5ft, as larger waves breaking on the beam have potential to capsize the boat. If we are in waves of that height, it was unintentional, and probably not having a good time! Rhythm is hardy and completed a circumnavigation with previous owners, during which she self-righted nicely after an over 90-degrees knockdown in a storm, but we are still of the opinion that heavy weather should be avoided. Forecasts, however, are not always accurate, and we’ve gone well offshore anticipating sufficient winds to outrun brewing lows, to instead be completely becalmed and consequently later caught in building gales.

Winds can be managed if the sail plan is adapted accordingly in a timely manner, reducing canvas early to ensure you don’t get overpowered, blow a sail, or find lengths of rope flailing in high winds with enough power to cause concussions, fractures, and ocular trauma. The mainsail boom swinging across uncontrollably has caused many a traumatic brain injury and injuries incompatible with life, alongside throwing unsuspecting sailors overboard. Risk assessments regarding wind direction and speed, alongside updated forecasts, must be undertaken frequently by the crewmember on watch.

Waves add further challenges. Beating into them is physically and mentally exhausting, it slows (and can halt) your vessel, so it is advisable to meet them at a 45° angle and speed to consistently reach the top and surf back down with decreased risk of pitchpoling or capsizing.


Seasickness is the common enemy and one we know well. We vomited across much of the Bay of Biscay as the boat rocked >90 degrees between port and starboard travelling downwind (that wind angle cannot stabilise the vessel against wave motion) in 3 metre swell. The consequences were inevitable – dehydration, fatigue, weight loss, and impaired decision making. I advise keeping cannula packs and IV fluids including dextrose onboard, and electrolyte/glucose tablets or sports drinks at bare minimum.

We carry various seasickness medications; however, the side effect of drowsiness caused me to fall asleep stood upright in the cockpit one night, and with little improvement in the vomiting department, were ultimately deemed a non-beneficial safety risk.

We will cautiously trial alternatives. So far Stugeron (cinnarizine) and Kwells (hyoscine hydrobromide) are both guilty of sending us to sleep without much symptomatic relief.

We have Metoclopramide tablets ready to trial next if needed, although currently have our sea legs and have felt okay in bigger seas. For emergencies (for example, if the engine breaks down and Tony needs to have his head in the engine bay whilst taking swell on the beam), we carry both buccal and IM prochlorperazine – the risk here being again drowsiness, however we have learned the extent to which adrenaline is fantastic as both an analgesic and for keeping us alert even when very fatigued and sleep deprived.

We have additionally trialled commonly recommended non-pharmaceutical relief such as ginger-stem syrup. Whilst it was ineffective, it at least made for a less unpleasant experience as it came back up than a lot of other foods and fluids do.

Maintaining oral intake despite ongoing vomiting has proven critical in rough times (literally and metaphorically) until the conditions ease or one has sufficient sea legs.

Speaking of legs…

Orthopaedic and musculoskeletal injuries in rough seas are common. Often from falling down the companionway stairs, or onto winches when trimming sails, or over deck lines. Fractured ribs, coccyx, limbs, and maxillofacial trauma are frequent outcomes.

“Should I clip in now?” If you’re asking- yes!

We use 3-point safety harnesses that attach from our lifejackets to points in the cockpit, the jackstays that run from along the length of the deck, and the mast. It limits how far one can be sent flying – overboard being worst-case scenario. I had one particularly terrifying moment in the Biscay holding on to the boom and mast for dear life to sort a caught mainsail car, whilst my feet were well off the comfort of the deck as the boat jolted side-to-side.

For these injuries we carry splints, bandages, and analgesics – from paracetamol through to IV tramadol, although tramadol isn’t ideal due to dosage toleration varying heavily between individuals and the common side effect of nausea… on a boat. I’m seeking an appropriate alternative from our supplier. Our Penthrox brings great reassurance however, and whilst we have ibuprofen and PR diclofenac, we also stock etoricoxib as an alternative NSAID as it typically carries less gastric risk, especially important when in hot climates, dehydrated, or having already vomited.

Should a fall or uncontrolled boom ever cause a head injury, basic airway management and life support equipment ought to be kept on any offshore vessel in case of reduced state of consciousness, with crew trained in its usage.

Wound Care and Haemorrhage.

We can’t discuss heavy weather without wounds and haemorrhage. Lacerations and degloving injuries are frequent, and missing digits among sailors due to winches and lines are a well-recognised occupational hazard.

For wounds we carry absorbent and non-adhesive primary dressings, burns dressings and gels, bandages, skin glue, steri-strips and suture pack, alongside iodine and antibiotics. Marine environments mean a state of perpetual dampness and increased infection risk, so no offshore vessel should be without flucloxacillin or a non-penicillin alternative.

For haemorrhage the basics are tourniquets, haemostatic powders and dressings, IV tranexamic acid for either intravenous or topical administration, and the ever-debated IV fluids. We are of the same blood type, so if ever caught in a desperate situation some interesting decisions may be made, with fresh whole blood transfusion having been shown to improve outcomes in military settings, and I believe worthy of increased conversation within wilderness medicine also.

The Mindset

When sailors consider heavy weather, they primarily consider capsizing, sinking, and falling overboard. But more frequent is prior disablement due to an injury that leads to diminished capacity to handle the boat safely in rough conditions. Risk assessment and swift medical management of sickness and injuries warrant a higher priority than often granted.

References and Further Reading

About Bryony Palmer

Bryony is a Registered Nurse with an interest in low resource and wilderness medicine, and following previous aid work experience she developed low-resource training for NHS staff during the pandemic. She is a member of World Extreme Medicine and is currently undertaking her Wilderness First Responder certification, followed by the University of Utah School of Medicine top up to Associate in Wilderness Medicine. She lives aboard her sailboat as she circumnavigates.


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