Chapter 5: Boating Emergencies—What to Do
Personal Injuries

Proper response to accidents results from good training and common sense. If an injury is minor, treat it immediately. If an injury is major, make the victim as comfortable and safe as possible until medical personnel arrive, assuming you have a way to call for help.

Cold Water Immersion and Hypothermia

Cold water immersion kills in several ways. The colder the water, the greater the chance of death. By understanding how your body reacts to cold water, you can prepare for and be better able to appropriately respond, thus increasing your chance of survival.

There are four stages of cold water immersion.

• Stage 1: Initial "cold shock" occurs in the first 3-5 minutes of immersion in cold water. Sudden immersion into cold water can cause immediate, involuntary gasping; hyperventilation; panic; and vertigo—all of which can result in water inhalation and drowning. Immersion in cold water also can cause sudden changes in blood pressure, heart rate, and heart rhythm, which also can result in death.
• Stage 2: Short-term "swim failure" occurs 3-30 minutes following immersion in cold water. The muscles and nerves in the arms and legs cool quickly. Manual dexterity, hand grip strength, and speed of movement all can drop by 60% - 80%. Even normally strong persons can lose the strength necessary to pull themselves out of the water or even to keep their head above water. Death occurs by drowning.
• Stage 3: Long-term immersion hypothermia sets in after 30 minutes, at a rate depending on water temperature, clothing, body type, and your behavior in the water. Cold water robs the body of heat 25 times faster than cold air. Hypothermia occurs when your body loses heat faster than it produces it, cooling the organs in the core of your body. Hypothermia eventually leads to loss of consciousness and death, with or without drowning.
• Stage 4: Post-immersion collapse occurs during or after rescue. Once rescued, after you have been immersed in cold water, you are still in danger from collapse of arterial blood pressure leading to cardiac arrest. Also, inhaled water can damage your lungs, and heart problems can develop as cold blood from your arms and legs is released into the core of your body.

Your chance of surviving a cold water immersion depends on having sufficient flotation to keep your head above water, controlling your breathing, having timely rescue by yourself or others, and retaining heat.

Prepare for boating in cold water conditions by always wearing a secured life jacket. Also wear layered clothing for insulation. Equip your boat with a means for re-entry (ladder, sling, etc.) to use if you should fall into the water.

Don't ever think that boating activities won't expose you to the risk of hypothermia. Wear rain gear when it rains. A windbreaker over a fleece jacket is very effective to protect against the wind. Hypothermia can occur on what begins as a warm, sunny day. In remote areas, carry matches and go ashore if you need to build a fire. Also carry an extra jacket, hat, and blankets. Remember that as a responsible operator, you should tell your passengers what to bring along for the outing.

Learn to recognize symptoms of hypothermia. They are listed here in order of severity. Shivering slurred speech, blurred vision Bluish lips and fingernails Loss of feeling in extremities Cold, bluish skin Confusion Dizziness Rigidity in extremities Unconsciousness Coma Death

Of course, the best prevention is to take all measures necessary to avoid capsizing your boat or falling into cold water in the first place. If you do fall into or must enter cold water:

• Don't panic. Try to get control of your breathing. Hold onto something or stay as still as possible until your breathing settles down. Focus on floating with your head above water until the cold shock response abates.
• When your breathing is under control, perform the most important functions first before you lose dexterity (10-15 minutes after immersion).
• If you were not wearing a PFD when you entered the water, look to see if one is floating around you and put it on immediately. Don't take your clothes off unless absolutely necessary. A layer of water trapped inside your clothing will help insulate you.
• Focus on locating and getting everyone out of the water quickly before you lose full use of your hands, arms, and legs. Try to reboard your boat, even if it is swamped or capsized, or anything else that is floating. Get as much of your body out of the water as possible. Even though you may feel colder out of the water, the rate of heat loss will be slower than if immersed in water.
• If you cannot get out of the water quickly, act to protect against rapid heat loss. In as little as 10 minutes, you may be unable to self-rescue. Your focus now should be to slow heat loss.
  • Stay as motionless as possible, protecting the high heat loss areas of your body, and keep your head and neck out of the water.
  • Safety typically looks closer than it actually is, so staying with the boat is usually a better choice than swimming.
  • Adopt a position to reduce heat loss. If alone, use the HELP (Heat Escape Lessening Posture) position; or if there are others in the water with you, huddle together.
  • If you must swim, conserve energy and minimize movement. Swim on your back with your upper arms against the sides of your chest, your thighs together, and your knees bent. Flutter-kick with your lower legs.
• Be prepared at all times to signal rescuers.

When treating victims of cold water immersion, you should:

• Get the victim out of the water as soon as possible. Remove the victim from the water gently and in a horizontal position.
• Prevent further heat loss.
• Treat the hypothermia victim gently and to your level of training. Be prepared to provide basic life support.
• Seek medical help immediately.

H.E.L.P.
Heat Escape Lessening Postures

Carbon Monoxide Poisoning

Carbon monoxide (CO) is an invisible, odorless, tasteless gas that is produced when a carbon-based fuel burns. CO can make you sick in seconds. In high enough concentrations, even a few breaths can be fatal. Sources of CO on your boat may include gasoline engines, gas generators, cooking ranges, and heaters.

Early symptoms of CO poisoning include irritated eyes, headache, nausea, weakness, and dizziness. They often are confused with seasickness or intoxication. Move anyone with these symptoms to fresh air immediately. Seek medical attention—unless you're sure it's not CO.

To protect yourself and others against CO poisoning while boating:

• Allow fresh air to circulate throughout the boat at all times, even during bad weather.
• Know where your engine and generator exhaust outlets are located and keep everyone away from these areas.
• Never sit on the back deck, "teak surf," or hang on the swim platform while the engines are running.
• Never enter areas under swim platforms where exhaust outlets are located—even for a second. One or two breaths in this area could be fatal.
• Ventilate immediately if exhaust fumes are detected on the boat.
• Install and maintain CO detectors inside your boat. Replace detectors as recommended by the manufacturer.

Before each boating trip, you should:

• Make sure you know where the exhaust outlets are located on your boat.
• Educate all passengers about the symptoms of CO poisoning and where CO may accumulate.
• Confirm that water flows from the exhaust outlet when the engines and generator are started.
• Listen for any change in exhaust sound, which could indicate an exhaust component failure.
• Test the operation of each CO detector by pressing the test button.

At least monthly, you should:

• Make sure all exhaust clamps are in place and secure.
• Look for leaks from exhaust system components. Signs include rust and/or black streaking, water leaks, or corroded or cracked fittings.
• Inspect rubber exhaust hoses for burns, cracks, or deterioration.

At least annually, have a qualified marine technician check the engine and exhaust system.

Natural air flows can suck fumes forward onto the vessel.

Swimmers should never enter an enclosed area under the swim platform—even for a second. One or two breaths of the air in this area could be fatal.

Carbon Monoxide Poisoning Situations

Descriptions of Various Carbon Monoxide Poisoning Situations	Illustrations
Blocked Exhaust Outlets can cause carbon monoxide to accumulate in the cabin and cockpit area.
Another Vessel's Exhaust that is alongside can emit carbon monoxide into the cabin and cockpit of your vessel. Your vessel should be at least 20 feet from a vessel that is running a generator or engine.
Teak Surfing or dragging or water-skiing within 20 feet of a moving vessel can be fatal. If persons are using a swim platform or are close to the stern, all gasoline-powered generators with transom exhaust ports must be off.
Slow Speed or Idling causes carbon monoxide to accumulate in the cabin, cockpit, and rear deck.
Station Wagon Effect causes carbon monoxide to accumulate inside the cabin and cockpit if you are operating the vessel at a high bow angle, if there is an opening that draws in exhaust, or if protective coverings are used when the vessel is underway.

Responding to Other Serious Injuries

Here are some proper responses to accidents that can occur while boating.

• Shock: The seriously injured should be treated for shock by keeping the victim warm, still, and in a lying-down position until medical attention arrives. Elevate the feet several inches except in cases of head injury or hypothermia.
• Bleeding: Bleeding usually can be controlled by applying direct pressure to the wound. If the bleeding is minor, apply first aid. If it is serious, apply a dressing, maintain direct pressure, and seek medical attention.
• Burns: In cases of burns, the immediate goals are to relieve pain, prevent infection, and treat for shock. Immediately place minor burns in cold water and apply a dry bandage after the pain subsides. Seek medical attention for major burns.
• Broken Bones: Seek medical assistance immediately for broken and dislocated bones. Apply temporary splints with care. An improper splint can result in lifelong disfigurement, but lack of a splint can lead to hemorrhage, shock, or death.
• Head, Neck, or Spinal Injury: In cases of head, neck, or spinal injuries, never move a victim more than is absolutely necessary. The water can provide excellent support until medical personnel arrive. If a victim must be moved, place him or her gently on a firm, full-length support.

A responsible vessel operator takes a certified course in first aid and CPR. Doing so enables you to respond quickly in emergency situations and to provide immediate care until the victim can be treated by a physician. When out boating, it can take a long time to get medical help.

A responsible vessel operator also keeps a first-aid kit on board. It should be waterproof and include: Assorted gauze adhesive bandages and pads Cotton and cotton-tipped applicators Scissors Antiseptic medications and lotions Aspirin or aspirin substitute Rubber gloves An extra towel