B) Maritime Industry

B.1.6 Petroleum activities

Details

Published: 03 April 2022

MIKE DOIG

Introduction

The Chinese drilled the first oil well in the 4^th Century but the industry did not start until the mid 19^th century when chemists in Scotland, Canada and the US first distilled oil to separate useful constituents such as kerosene, paraffin wax and lubricating oil. The industry increased dramatically and the oil majors were formed in the second half of 19^th century with the most famous, Standard Oil, formed in 1865. The Anglo-Persian Oil Company followed in 1907 and these companies and their successors remained very commercially successful through the two World wars.  Influence subsequently moved to the oil producing nations with the formation of OPEC in 1960. Petroleum production peaked in the 1970s and despite subsequent oil gluts and massive price swings the oil and gas thrives as a multi-million dollar industry and continues alongside renewables to provide much of the Worlds energy in the first decades of the 21^st century.

Offshore Oil Installations

Offshore oil installations are found worldwide and are fixed leg, jack-up or floating semi-submersible structures. The mobile installations, or drilling rigs, are used for exploration, whilst the fixed leg  platforms are used for oil recovery and production.

There are 12,000 offshore oil and gas platforms worldwide and these vary immensely in design and size with many being unmanned, and many with multiple remotely controlled satellite subsea wells. Deep waters are served by FPSOs (Floating production storage and offloading) vessels. Where they are manned installations these complex, compact facilities provide a challenging environment for the workforce, usually up to 150 in number. They work continuous shifts, often 12hrs at a time, for up to three weeks or more.

Oil production requires a chemical processing and heavy engineering plant to be housed in confined spaces, adjacent to administration and living quarters. There is limited communication to the shore, often hundreds of kilometres away, with logistical support provided by supply vessels bringing routine equipment, water and food, with helicopters moving personnel and emergency supplies. In some areas, such as the North Atlantic, west of the Shetland Islands, these installations can be isolated by weather conditions for significant periods of time.

Health requirements

In many parts of the World there is specific health legislation, and industry guidance, that relates to the heath of the offshore workforce. These standards, many originally developed for the UK offshore oilfields, ^1-19 have often been adopted by the industry in other parts of the globe, as accepted best practice.

Workers are expected to be free of medical conditions that might cause a safety threat to themselves, colleagues or others, and to be in a physical condition such that they can fulfil the critical physical capability aspects of their job. An on-board sick bay manned by a trained medic allows for diagnosis and treatment of intercurrent illness and injuries, the medic in turn is supported by higher level medical advice from doctors available for consultation onshore.

Individuals who are unlikely to return to work in a reasonable period of time, and those who are more seriously ill or injured, are evacuated by helicopter either on routine or emergency flights.

The medic will also supervise the installation’s food and water hygiene and will lead the health education initiatives that are regularly run offshore.

References

1          United Kingdom Continental Shelf Act 1964.

2          The Offshore Installations (Safety Case) Regulations SI 2005/311

3          Offshore Installations and Pipeline Works (Management and Administration) Regulations 1995

4          Offshore Installations and Pipeline Works (First-Aid) Regulations 1989 SI 1989/1671. London: The Stationery Office, 1989.

5          The Offshore Installations (prevention of Fire and Explosion, and Emergency Response) Regulations 1995. Approved Code of Practice and Guidance L65. London: HSE Books, 1995.

7          Energy Institute. A recommended fitness standard for the oil and gas industry
London: Energy Institute 2010

8          Energy Institute. Fitness assessment manual. London: Energy Institute 2011

9          Energy Institute. Medical standards for fitness to wear respiratory protective equipment. London: Energy Institute 2011

10        Energy Institute. Guidelines for the medical aspects of work for the onshore oil industry. London: Energy Institute. 2011

11        Oil and Gas UK. Guidelines for medical aspects of fitness for offshore workers. Issue 6. London: Oil and Gas UK 2008.

12        Basic offshore safety induction and emergency training and further offshore emergency training. Offshore Petroleum Industry Training Organisation, Aberdeen, 2003.

13         UK Civil Aviation Authority.  Safety review of offshore public transport helicopter operations in support of the exploitation of oil and gas. CAP1145 report   20 February 2014. 

14        Minimum Industry Safety Training Standard (MIST) Revision 1 Amendment 2. Standard code: 5301. Offshore Petroleum Industry Training Organisation, Aberdeen, 2017.

15        UK Offshore Operators Association. Industry guidelines for first aid and medical equipment on offshore installations. London: UK Offshore Operators Association, 2000.

16        Oil and Gas UK. The management of competence and training in emergency response for offshore installations. London: Oil and gas UK, 2010. Oil & Gas UK.

17        Equality Act (Offshore Work) Order 2010 HMSO, 2010.

18        Energy Institute. Guidance on Health Surveillance Energy Institute. London 2010

19        UK Offshore Operators Association. Environmental health guidelines for offshore installations, Issue 3. London: UK Offshore Operators Association, 1996.

Platform Supply Vessels

Platform Supply Vessels or Offshore Support Vessels are critical purpose built vessels that sustain the demands of the offshore energy production, construction and maintenance projects. They are typically 50-100m in length with a crew of up to 35^1,2 and are specifically designed as logistical support to oilfield operations. They fulfil many roles including the delivery of materials, plant, tools and equipment, general supplies and containered food, carried above deck, with bunkered fluids such as Diesel fuel, drilling mud, chemicals, or potable water, below decks.  These vessels fulfil a vital necessity in the support of oilfield operations on the high seas.

In some areas they are also the principle method of transportation of the crew. Some vessels have a firefighting capability and are equipped with fire monitors for fighting platform fires. Others are equipped with oil containment and recovery equipment to assist in the clean-up of an oil spill at sea.

These vessels are also used for the removal of installation waste and rubbish, anchor handling and may also be used to stand off platforms providing a search and rescue function.

The crew remain on board for 4-6 weeks usually on a 12hr rota. Accommodation may involve shared bathroom facilities, with common mess and entertainment facilities.

Crew members are expected to fulfil the normal criteria for seafarers’ medical standards,³  and in addition, to maintain a level of fitness that reflects the heavy manual tasks associated with the duties of loading and unloading these vessels whilst at sea in inclement conditions.

Platform Supply Vessels do not normally have a dedicated medic on board, but may have an advanced first aider, with the crew trained in first aid. Medically trained personnel may be included where the vessel has increased Persons On Board in remote operations.

Diving Support Vessels

Diving support vessels (DSV) are specifically designed and equipped with professional diving equipment for effective diving operations in harsh environments. This often includes full saturation diving facilities with an underwater bell and on board decompression facilities. DSVs are used for underwater diving operations carried out below and around oil production platforms and their related facilities. They are used for the inspection, maintenance and underwater repair of production platforms and related installations in open waters below the surface. They are also used in pipeline maintenance, construction and well intervention. Further information on diving can be found in Ch 3.2.8.

References:

1          Marine Insight.    www.marineinsight.com

2          Wartsila Encyclopaedia of Marine technology.        www.wartsila.com/encyclopedia

3          UK Government Maritime and Coastguard  Agency.     https://www.gov.uk/guidance/seafarers-medical-certification-guidance

4          Offshore Fleet  www.offshore-fleet.com

Relationship between operators and contractors

Whilst the licence owners of the oil field will be represented as the Operator of the oil installations with core production and maintenance crew, many of the offshore skills will be represented by contractor crewmembers. This allows for the changing operations involved and certain roles may be sub contracted by the contractor. This includes construction operators, scaffolders, crane drivers etc.

Platform supply vessels and diving support vessels will be hired on contract for defined periods which reflect daily offshore activity and longer term general economic variation. They may be owned by the same parent company or a contractor.

The staffing of both rigs and vessels with operator staff, contractor, sub-contractor and even sub sub contractor staff can be difficult in terms of employment contracts, schedules, the willingness of crew to seek health care on board and evacuation if necessary and for cohesiveness of the crew on board.

B.1.4 Inlands waterways

Details

Published: 03 April 2022

PATRICK STEENACKER – TIM CARTER

Introduction

The crews of vessels working on inland waterways have many of the same duties as those onboard seagoing shipping, but there are some important differences. Navigation is in restricted and often congested waters. Ships are usually smaller and with lower freeboards and there is frequently a need to moor temporarily while passing through locks. Thus, the seafaring skills and capabilities, including health related ones, needed are similar to those for a seagoing ship. However, land and shore-based health care facilities are generally close at hand in the event of an emergency. This means that fitness to work as crew on an inland waterway vessel is concerned with task related capabilities rather than the risks of illness requiring a medical consultation developing while on board.

Types of inland waterway

1. Rivers have been used for communication and transport since prehistoric times, the Nile in Egypt being a prime example. The characteristics of the river determined vessel design and operation. Even in the ancient world rivers were improved by dredging and by the provision of weirs and early forms of lock.
2. Similarly large lakes, such as those of Africa and North America have long been highways for communication as well as fishing grounds.
3. Early canals were cut in Roman times and in ancient China to supplement and connect rivers. There were major developments in canal building in Europe during the 17^th and 18^th Centuries and in North America a bit later. Locks were perfected and horse haulage for boats adopted until replaced by mechanical propulsion.
4. Both canals and rivers served seaports, situated on estuaries or bays. Often such estuaries and other tidal inlets such as fjords were served by boats and ferries that never went on to the open seas.

Many inland waterways are within a single national jurisdiction and national requirements for navigation, including those for crew competence and fitness, are the norm.  Sometimes, particularly for estuaries, fjords and tidal rivers where seagoing vessels are also present, the same standards as those for international maritime transport are applied. Where rivers, lakes or canals also cross-national boundaries, such as the Rhine in Europe, international agreements on navigation standards were sometimes developed at an early date.

Transnational waterways

EUROPE

The Central Commission (for the Rhine) (CCNR) was formally constituted in 1815. It was based on two key principles: the creation of an international river organisation, and the establishment of the principle of the freedom of navigation.

The Central Commission resumed its work after the Second World War in 1945, with American, Belgian, British, French, Dutch and Swiss delegations.

The German delegation did not resume its place until 1950. The Central Commission contributed to the return of activity to the Rhine corridor. Several committees were set up by the Central Commission, which also established a “boatman’s passport” and a rationing card.

The Commission also concerned itself with simplifying Customs formalities. It intervened with the military authorities for the removal of military bridges that were hindering navigation. Collaboration with other international organisations developed, particularly with the High Authority of the European Coal and Steel Community and subsequently with the European Commission. Specific agreements were concluded regarding the working conditions, social security arrangements, competencies and medical fitness for boatmen on the Rhine.  The principles and the rules governing navigation on the Rhine have been taken up and extended to inland navigation throughout Europe. The Rhine is now an integral part of the European network of inland waterways, but it remains the most active and the most highly evolved section. The Central Commission is working increasingly on matters that concern not only the Rhine but also inland navigation in Europe as a whole. Cooperation with the European Union is increasingly close. The United Kingdom withdrew in 1993, but the Central Commission welcomes many “observer States”, mainly from the Danube basin.

All Member States of the European Union now have the same conditions of access to the Rhine as the CCNR members. To this end, the CCNR and the European Community have adopted identical regulations defining the vessels belonging to Rhine navigation or to Community navigation.

The European committee for drawing up standards for inland navigation (CESNI)

• adopts technical standards in various fields, about vessels, information technology and crew to which the respective regulations at the European and international level, including the European Union and the CCNR, will refer with a view to their application;
• deliberates on the uniform interpretation and application of the said standards, on the method for applying and implementing the corresponding procedures, on procedures for exchanging information, and on the supervisory mechanisms among the Member States;
• deliberates on derogations and equivalences of technical requirements for a specific craft;
• deliberates on priority topics regarding safety of navigation, protection of the environment, and other areas of inland navigation.

AFRICA

Inland navigation is important in Egypt (Nile), West and Central Africa (Congo).  There is international collaboration in relation to some inland waterways in Francophone Africa. This is part of wider collaborative initiatives.  Relevant aspects of this collaboration are:

• Assistance to states on the survey of boats;
• Control the implementation of inland navigation codes (registration, signaling, issuance of navigability and navigation permits, etc.);
• Developing common regulations to ensure safety;
• Defining and enforcing measures to reduce accidents;
• Coordinating development and maintenance work;
• Seeking funding for the acquisition and management of hydrological and hydrographic data;
• Monitoring, in collaboration with national institutions, the execution of network maintenance works.

With more than one-third of the rail network not fully operational and very few roads, the complex network of waterways is critical for the local and regional economies. A large part of the Congo Basin regions is inaccessible by means other than inland navigation. Moreover, despite the slow pace, the low cost of water transport makes them the main mode of transport for goods and people.  Most of the goods on the river are transported on convoys consisting of a push boat and several barges (with a capacity of 500 to 2,000 tons).

Most captains navigate without any navigation documents and do not use other navigational markers, apart from their knowledge of the river and a handwritten list that records distances between villages.  Work to revise, update and better specify the general cartography and dangers of navigable waterways is in progress led by the Commission for the Congo Basin (CICOS).

In addition, in collaboration with the relevant services of its Member States, it is developing practical databases on accident and incident statistics, flow of goods, fleet registers, a port directory and a hydrological information system. No information is available on provisions concerning the regulation of working conditions, social security, crew competence and fitness assessment.

NORTH AMERICA

Many of the waterways, such as inshore canals and major river systems like the Mississippi are entirely under the jurisdiction of the USA. Navigation in the Great Lakes and the St Lawrence Seaway is a shared responsibility of USA and Canada. Some of the vessels plying on these waterways are very large and in addition tugs move large chains of barges carrying bulk liquid and solid cargoes over long distances.  Ocean going vessels have access to the Great Lakes and are subject to the same international requirements as in international waters. However, there are a wide range of US and Canadian regulations that also need to be observed. These concern pilotage for all non-North American vessels and port and harbour clearance rules, which differ according to the jurisdiction of each port. Also, the Seaway and Great Lakes are, to an extent seasonal navigations as large parts are ice-bound in winter.

REST OF THE WORLD

River and canal transport elsewhere is, with few exceptions such as the Mekong in south-east Asia, within single national jurisdictions. Important waterways include the Amazon and River Plate in South America and the major rivers of China and India. National codes for such waterways vary in detail, broadly mirroring those for other groups of workers in the country, but sometimes with additional provisions to assure fitness to work or to provide medical care when away from home.

Working and living on board

The living conditions on board differ with size of vessel, shipping company, region and local level of economic development and crew expectations. On small vessels accommodation may be limited to cramped sleeping quarters, a single multi-purpose mess room and a galley.  Food may be of poor quality and hygiene, especially for food storage and preparation, can be hard to maintain in such situations, posing risks to crew health. This is especially the case on owner managed vessels, as those belonging to larger fleets may well have to comply with company standards. This may also apply to personal safety equipment, such as fire extinguishers, fire suits, breathing equipment, first aid kit, etc.

Welfare arrangements for inland waterway crews are limited and contact with home is either done using mobile phones, as in African countries, or by internet where there is 4G coverage.

Medical aspects

Many of the health risks are similar to those for other seafarers. In particular injuries associated with mooring and rope handling are frequent. Additional risks do occur in tropical countries, on fresh waters close to shore people are much more exposed to insect vectors, which can transmit malaria and other infections. Food may be purchased locally with risks, especially in South America and Africa, from adulteration, spoilage, bacterial infections and parasitic diseases. Seasonal risk factors are also important. Prolonged high humidity during the monsoon increases the likelihood of skin infections, both primary and secondary to injuries. Drowning is also an ever-present risk.

In developed economies, medical fitness criteria are specified, for instance for those working in the Rhine/Danube waterways. These are primarily concerned with safe navigation, but also provide an opportunity to review health with crew members and to offer vaccinations. Additional requirements may be in place where cargoes pose health risks.

Emergency medical care may be required, either within the crew-member’s home country but distant from their residence or in another jurisdiction. This may be, as in Europe, covered by international agreements. Care on board is usually limited to first aid provisions. In less developed countries medical emergency arrangements for crewmembers are limited and in line with local health care provisions

Passenger vessels on inland waterways

Some waterway systems such as the Rhine/Danube, the Russian waterways and the Nile have dedicated vessels accommodating cruise passengers. As with cargo transport the requirements for crew competence and fitness are variable. Passengers themselves may have to make a declaration about health before travelling but are expected to carry their own insurance to cover medical emergencies.

A few large waterways such as the St Lawrence and the Amazon are on cruise liner itineraries as are many estuaries leading to port cities. The same medical arrangements to those on the high seas apply, but in tropical waters there may be additional risks from insect vectors of disease.

B.1.5 Fishing industry

Details

Published: 03 April 2022

Pal Weihe; Juan Ignacio Alcaide

Introduction

The world of fishing is huge and as an industry it has existed from ancient times to the present. A large variety of technologies are necessary to harvest living aquatic resources, including vessels and equipment as well as fishing gears and methods [1]. Throughout time fishers have crossed the sea in search of more generous waters, setting sail from ports or other areas of the coastline to the open seas. On fishing vessels, fishers are working on an unstable surface, at the mercy of waves and harsh weather.

The diversity of fishing vessels      

In 2014 the global fleet comprised around 4.6 million vessels, the majority of which were less than 12 metres in length. In 2016 it was estimated that around 44 600 large vessels of over 24 metres were  in operation. The largest fleet was in Asia, with 3.5 million vessels (75% of the global fleet) (Figure 2-3) [3].

Fishing vessels vary widely in terms of size and configuration, ranging from small boats with one crew on board to larger vessels that carry ice to refrigerate fish for a few days, up to large factory vessels that catch and then process fish on board. The oceanic species are caught by using trawl, seine, longline, jigging reel, gillnet and by dredging the sea floor and the processing methods vary from just cooling or freezing the fish to filleting, boiling and fishmeal production. These larger vessels may have more than one hundred seafarers on board and the diversity of a fishing vessel as a workplace is as great as that of factories on land, depending on the size and sort of fishery. In small fishing vessels, e.g., undecked boats, seafarers are exposed to weather and wind during the whole trip whereas in the large floating factories seafarers may work at a conveyor belt under deck with regular working hours.

The large vessels often have high standard accommodation. On board the newest and best vessels, each seafarer has his own room including toilet, shower and access to internet allowing communication to home. On the small fishing vessels, however, the crew facilities are often primitive with shared bedrooms and shared sanitary facilities and without any options of private telecommunication.

Crewing of fishing vessels

The crewing of fishing vessels is usually in one of two models, a national model (coastal fisheries) and an international model with regulations that are often difficult to apply. Each of these models are affected by multiple factors and inherent to the development of the activity, these can be grouped into social, economic, regulatory, and political factors.

The international fishing industry is characterized by long hours and strenuous activity. For many years, the international organisations have fought to improve living conditions on fishing vessels and tried to eliminate inequalities in issues such as: medical care, payment of fishers, hours of rest, occupational safety, health and accident, accommodation, etc. Relationships between employers/shipowners and workers are diverse. At the global level, there are two main types of payment system in the sector, the flat wage and the share system, involving catch or on bonuses.

Medical fitness to work at sea

The ILO Work in Fishing Convention 2007 states that fishers cannot work on board a ship unless certified medically fit for their duties. Such a certificate is valid for one or two years and as a minimum should confirm that the fisher’s hearing and sight are satisfactory for their duties on the vessel. In addition, a medical examination should establish that a fisher does not suffer from any medical condition likely to be aggravated by work at sea, likely to render them unfit for service, or endanger the safety or health of anyone else on board.

The location of fishing and the risks involved

Fishing at sea has been and is still one of the most dangerous of all professions.

Fishery is performed on all waters around the globe. In coastal waters, in lakes, in rivers but also in oceanic deep waters. This means that the climatic conditions surrounding fishery can vary a lot from the tropical to the polar climate, from heat that demands cooling to stay comfortable under deck to extremely low temperatures when fishing in the arctic waters. The cold can pose a threat to the safety of the ship due to ice formation and the risk of capsizing but also to the fisher due to hypothermia for a fisher falling overboard.

Common to all fishing vessels is the exposure to current and wind. Current and wind can separately and together create big waves, which can make the working environment very exhausting, and breakers may lead to the sinking of a ship. Regardless of the location of fishing and the seasons, fishing vessels foundering, or capsizing has continuously been the main cause of loss of life from vessel casualties in the fishing industry. Collisions, grounding, fires and explosions have caused heavy loss of life more sporadically. The severity of damage to the fishing vessel varies with the

• type of vessel accident (capsize, collision, explosion, fire, flooding, grounding, and sinking)
• vessel characteristics (size, age, seaworthy, maintenance)
• type of vessel propulsion
• type of vessel hull construction (wood, aluminium, steel, or fiberglass)
• weather condition (visibility, losses of vessel stability and manoeuvrability)
• location (distance to shore)
• time of vessel accident (night-time versus daytime)
• season (summer or winter)

Larger vessels tend to be at sea longer than smaller vessels, and hence their overall exposure to the risks involved in fishing will be greater [8][9][10]

Specific risks in the fishing sector

There is a broad spectrum of occupational risk within the fishing sector including chemical, physical, biological and human factors such as fatigue. More information on risk in these areas is available in Ch 6. These risks may cause musculoskeletal, dermatological, respiratory, ophthalmological and other problems, including loss of life.

Over 24,000 fishers die every year, the large majority on board small fishing vessels after a vessel accident or a fall overboard [2] [3]. Work related accidents on fishing vessels are more common than accidents in most workplaces on shore. The main reason for this is the movement of the ship. The deck is almost constantly in motion, which puts greater demands on the fisher to keep his balance when carrying a load and when having to pay attention whilst solving a task such as repairing a trawl. In addition, when fishery is good, the crew normally work long shifts and often suffer from sleep deprivation. This may cause fatigue and negligence, which also increases the risk of accidents. Further information on the effects of fatigue is available in Ch 6 and 7.

Risk related to physical load are also common in the fishing sector and musculoskeletal disorders often develop because of the physical demands of work, forced postures and repetitive movements that are undertaken.

Fishers also are exposed to biological agents, through contact with animals or with products of animal origin, including fish. Specifically in the sector, wounds obtained whilst extracting the catch from the gear can become infected and there is always the chance of finding a poisonous species of marine organism mixed in with the catch. Respiratory disorders are related to aerosol exposure to protein particles from saltwater fish, crustaceans or molluscs that can cause rhinitis or asthma. Work on deck can involve exposure to the elements, cold or hot and lead to hypothermia, frostbite or heatstroke etc. Work in the engine room can also lead to heatstroke etc.

The crews of fishing boats are permanently exposed to high noise levels, making hearing loss one of the most common occupational diseases. Noise levels vary according to the areas of the boat and are linked to sea and weather conditions. Further information is available in Ch xxx. Vibration is another common problem and further information is available in Ch. 6.7.

B.1.3 Yachting

Details

Published: 03 April 2022

SPIKE BRIGGS

Types of Yachting

Competitive sailing

History

Racing in sailing boats started over 300 years ago in Northern Europe. However it probably started much earlier in ancient civilisations around the world.

Racing in yachts has always been risky. In the early days, equipment was quite basic, with little regard for individual safety, and certainly no personal safety aids such as life jackets. However, the sailing was somewhat less arduous, with vessel speeds below 10 knots. Generally, races were held within sight of land, and only in daylight hours.

The advent of the iconic J Class yachts in the early 20th century heralded a significant increase in competition and boat speed, and in the risk to crew. The more recent advent of foiling racing boats, with speeds in excess of 50 knots, has certainly brought a level of risk to sailors similar to motor car racing, but complicated by the fact that the racing takes place on water; thus, access to the scene of an accident may be delayed for logistical problems.

Inshore

Worldwide, the majority of competitive sailing on the sea takes place in inshore waters. Inshore racing is yacht racing not in protected waters but along and generally within sight of land or from land to nearby islands, as distinct from offshore racing across open water and oceans. The duration of races may be daylight only, overnight or passage races of several days. Some races, such as the Swiftsure Yacht Race, are actually a group of inshore races of various distances along overlapping courses to allow for different classes and skills. Depending on location, stability and safety equipment requirements will be more extensive than for harbor racing, but less so than for offshore racing. Different levels of requirement for navigation, sleeping cooking and water storage also apply. By definition, such waters are more sheltered, so environmental exposure tends to be less. However, overall risk is not insubstantial for the following reasons:

• There are a large number of participants as this type of sailing is relatively accessible to many;
• The health of individuals may be more variable than that for offshore sailors;
• The speed of small racing yachts and dinghies has increased markedly over the past ten years;
• Racing in close proximity to other boats, around a circumscribed, marked course, increases the risk of collisions, and injury to crew;
• Racing takes place all year, and thus exposure may be a risk for the unprepared.

However, risks to crew may be mitigated to a degree by the following factors:

• Proximity of rescue facilities such as umpire/rescue RIBS on the course;
• Sailing taking place predominantly within helicopter range;
• Protective clothing and rescue breathing kits that are increasingly worn by crew on high-speed racing boats.

Offshore

Offshore yacht racing has increased markedly over the latter half of the 20^th century, with deep ocean races now commonplace. Offshore yacht races are held over long distances and in open water; such races usually last for at least a number of hours. The longest offshore races/transoceanic races involve circumnavigation of the world.

The most frequent route for deep ocean yachts races is transatlantic, with a race duration of anything from 6 days to over 24 days. There are several races every year, involving upwards of several hundred boats. Racing offshore requires crew to live on board whilst racing for extended periods. The attendant problems are described below.

Offshore racing boats may vary from as small as 6m length, to well over 30m. The smaller boats are at increased risk due to small size in relation to the waves and swells on the ocean, whilst larger racing yachts may be at risk due to high speeds, loss of control and traumatic capsize at speed.

Round-the-world races, for both professional and amateur crews also occur every year or so, and most such races venture in to the most isolated oceans in the world. These races take from as little as 40 days, to over 150 days. Each race may involve single boats, on record breaking attempts, to races involving over ten boats.

The rules for these races may require all boats to be identical, or near-identical, with very similar boat speed. Some races allow a variety of designs, with a large variation in boat speed. Thus, with boats of different design, the racing ‘fleet’ may be spread out over a large area of ocean, with the attendant difficulty in one boat lending support to another boat in the event of difficulty.

Many offshore races involve single- or short-handed crew, with the attendant problems of lack of sleep, exhaustion, inability to maintain a continuous lookout for collision avoidance, and lack of help on-board in the event of a disabling accident. Such sailors are exceptionally resilient to such risks, and have undertaken round-the-world races in impressively short durations. Larger boats, single and multi-hulled, may have a crew of between 10 and 15, with a watch system, to support racing at high speed on a continual basis.

Medical support

Most offshore yacht races are controlled by recognised race organisers, with good experience of such events. As part of the preparations, most authorities will stipulate minimum levels of medical inventory to be carried by every yacht, together with a minimum level of first aid training for crew. In addition, certainly for round-the-world yacht races, the race will have access to a telemedical advice service, which will be fully cognisant of the medical inventory carried by each yacht, and the level of training undertaken by the crew.

Rescue for serious medical and trauma problems can prove to be risky, protracted and costly. Such rescues usually involve coordination by global Maritime Rescue Coordination Centres (MRCCs), and often involve any commercial or military shipping that is closest to the yacht in difficulties. These vessels may have only basic medical resources on board, but can expedite transfer to the nearest definitive medical facility. Even then, the time for transfer can be over a week or more.

Leisure sailing

There has been a momentous worldwide increase in sailing for pleasure, over the past thirty years. This has been made possible by the fundamental evolution in global communications, coupled with the attendant transformation in navigation systems. Also, with the advent of the world-wide web, distant places are much more accessible over the internet, and the aspirations of would-be sailors more likely to become a reality.

Yachts now venture to all corners of the world, on a regular basis. Transpacific voyages, both alone, and in the company of other yachts on ‘world rallies’ are frequent, as are voyages to the Antarctic, and through the north-east and north-west passages.

Yachts used for leisure sailing across oceans vary widely in both size and sail plan. Some boats are smaller than 10m in length, whilst the largest may well be over 100m.

Sailing crew can be of any age, from new born as part of families sailing around the world, to octogenarians and older, who are taking the advantage of retirement to literally see the world. Such a wide spectrum of sailors includes the whole array of problems that may affect the human condition.

Leisure sailors also vary widely in the preparation that they may have made for their voyages. Some will be well-trained, and have a veritable cornucopia of medical inventory on-board, whereas others will have very little. Yachts who are better prepared may also have arranged shore-side telemedical support, to guide them when treating serious illness or injury on-board. Generally, the larger the yacht, and the more remote the voyages, the better prepared the yacht will be for managing both medical and trauma emergencies.

Commercial yachting

In common with both leisure sailing and yacht racing, there has been a significant increase in commercial yachting globally. As with the other areas of yachting, there is a wide spectrum of both boat size, number of crew on board, and how vessels are organised and operated.

The predominant form of commercial yachting takes the form of chartering. Vessels vary from less than 10m, to over 100m. The smaller vessels usually are offered for ‘bareboat’ charter, in that they have no professional crew included in the charter contract. Most vessels larger than 20m will have at least a professional captain and stewardess. The large vessels of over 50m will usually have a permanent professional crew of more than ten, and sometimes more than fifty.

Statutory authorities, such as the Maritime and Coastguard Agency in the UK, usually regulate the medical inventory, level of medical training and availability of a telemedical advice service

The range of operation of commercial yachts is worldwide. Larger yachts are often involved in exploration and diving operations in very remote locations, with the attendant health risks. They are usually well-equipped, above the level required by the statuary authorities.

Risk assessment

Both yacht racing and leisure sailing involve significant risk. The level of risk depends upon boat activity and crew type. It is estimated that the risk of

• Requiring treatment is probably about 1:10,000 crew miles
• Requiring external advice is probably about 1:100,000 crew miles
• Evacuation is probably about 1:1,000,000 crew miles
• Life-threatening injury is probably about 1:10,000,000 crew miles

Specific risk factors include:

• Crew composition and fitness.
• Proposed route:
• Distance from land (in/out of helicopter range of 200 miles).
• Distance from frequented shipping routes.
• Special obstacles, e.g. ice, fog, other shipping.
• Piracy is a risk in some regions. See: M https://www.gov.uk/ sea-river-and-piracy-safety
• Length of time at sea.
• On-board medical skill.
• Shore support.
• Medical kit contents.
• Communication availability.

Typically, about half of all injuries happen below decks and these areas look and feel very different should the boat turn on its side, or even upside down. Consideration must be given to escape routes if the boat remained upside down (a problem with yachts if they lose their keel), and how this could be achieved in the dark.

The sailing environment

Weather

Weather forecasts are increasingly accurate and can be accessed anywhere. GRIB (GRIdded Binary) files are readily available from a variety of websites via satellite phone or single side band radio (SSB), giving high definition of weather conditions local to a yacht’s position. But a forecast is only helpful if accessed in good time and interpreted correctly. The crew of a yacht must think ahead, get information, plan accordingly and be prepared for anything. Bad weather takes a toll on the crew and the boat; both must be in the best condition possible, and both require regular maintenance. Hot, humid tropical weather in the tropics can lead to exhaustion, dehydration, infections, and sunburn. Prolonged cold conditions make it hard to dry anything and can lead to the insidious development of hypothermia.

Trauma and the deterioration of medical conditions are most likely during poor weather. It is important to plan accordingly - where is the best place for the medical kit to be accessed when the boat is falling off waves, and where is the best place to put a casualty so they do not come to further harm, and can be examined and treated?

Navigation

Sailors should always know where they are and where they are heading. It is important to keep in contact with shore based support - if disaster strikes, rescuers need to know where to look for the yacht. Systems used for navigation include

• Global Positioning System: over the past 25 years, universal access to GPS has made navigation far more accurate and less dependent upon weather conditions. However vessels should always have a least one backup system, and another system that gives latitude and longitude that can be plotted on a paper chart. All technical systems require electricity, which also requires multiple backups. Solar panels or a wind turbine can provide an alternative power source to the vessel’s generator. Electrical supplies for several days must be available in a life raft as well.
• Paper charts (Standard Nautical Charts) and Pilots (Sailing Directions) covering all sail areas and ports of call are still mandatory parts of the vessel’s library.
• Astronavigation is the ultimate backup plan but requires detailed training and frequent practice to be reasonably accurate.

Search and rescue

Ocean sailing can put a yacht crew more than 2 weeks from appropriate medical help. Crews might have to cope with serious medical problems during this time, and must have a realistic expectation of what is possible if someone is seriously injured or becomes ill. Communication must be reliable, and may be via:

• VHF radio and mobile telephone when within range of shore.
• Satellite telephones (email or voice).
• Inmarsat Standard C.

Telemedicine is increasingly common but requires video or image transmission and reception, together with the medical expertise to interpret those images. Shore support for medical emergencies is possible via international maritime rescue coordination centres such as MRCC Falmouth (a Maritime and Coastguard Agency service). There are various other organizations that provide support for expeditions to remote places, such as Medical Support Offshore Ltd, based in Southampton, UK, and the British Antarctic Survey Medical Unit (BASMU), based at Derriford Hospital, Plymouth, UK. Larger expeditions may organize their own shore medical support team that can then be tailored to the crew’s specific requirements.

Sailors. Humans on long voyages

Sailing in remote areas is no longer the preserve of the young and fit.

Rigorous, more remote, longer, polar or tropical routes require fitter crew and better medical training for skipper and medic. Extreme weather conditions—high winds, wave impact, motion, salt water, humidity, heat, cold, and frequent immersion—should be expected, and prepared for. Weather, either cold, hot or rough can be exhausting and with no escape, crew have to cope whatever the weather. Storms do not blow forever, although at the time it may feel as if they do.

Isolation from assistance is a major factor when assessing the fitness of crew, planning medical kits, and arranging medical shore support. Trauma, illness, and physical danger are medical and mental challenges, and are common, pre-existing medical conditions may relapse. Short-handed crew work harder, become more exhausted, and consequently incur more injuries and illnesses.

Seasickness is a frequent and often disabling condition. It can usually be treated effectively, but vomiting may prevent the absorption of other oral medications or contraceptives.

Fear and danger are real concerns offshore. Rough weather, accidents, other emergencies, and even possibly the catastrophic experience of having to take to a life raft after a vessel sinks bring out both the worst and the best in crew. They may react by becoming aggressive or withdrawn and depressed. Mutual watchfulness and support, with honesty about one’s own emotions, will result in a strong team more likely to remain cohesive, and survive.  Team dynamics are central to every facet of boat performance; a happy and healthy boat performs well.

Boredom may sometimes beset crew; youngsters are particularly at risk. Usually they can be distracted by a never-ending list of maintenance tasks, but reading, schooling, a structure for the day and pastimes such as musical instruments may alleviate occasional tedium. Well-planned watch-keeping schedules are essential to minimize fatigue.

Health requirements

There are no official or regulatory standards for medical screening in offshore racing but crew should be physically fit prior to the expedition. Medical screening may take the form of a self-declaration questionnaire, with or without confirmation by the family doctor, or it may involve a formal physical examination and testing. This screening will appear onerous but will avoid potentially serious complications, which may endanger the whole boat. The final decision on fitness is the responsibility of the examining doctor.

Particular attention should be paid to cardiopulmonary fitness and lower limb strength, which will decline when confined on board a yacht for several weeks.

In addition there is a relatively high risk involved in taking crew who are dependent on oral medication for life-threatening conditions, such as organ transplant, epilepsy, and heart disease. Insulin-dependent diabetes mellitus and severe asthma also involve greater risk offshore. Stringent exclusion criteria should be applied to voyages beyond helicopter range and might exclude crew with any of these conditions.

Living on a yacht

Personal space is limited, but having ownership of at least some space, no matter how small offers some compensation. Living conditions are enclosed, cramped, and often difficult to keep clean, leading to the risk of community infection.

Formal standards for accommodation at sea only apply to commercial vessels. Other vessels come in all shapes and sizes, accommodation varies from air-conditioned state rooms with en-suite facilities on super yachts, to hot-bunking cots on racing boats.

Racing boats are stripped out, with no soft coatings on surfaces, which are unforgiving as a result. Crew sleep in sleeping bags on ‘cots’: fabric slung between two longitudinal poles with a ‘lee cloth’ to prevent unscheduled exits in rough weather. Commonly members of the off-watch climb into the bunk just vacated by the on-watch, a process known as ‘hot-bunking’. Sleeping weight is kept on the windward side, or towards the stern when sailing downwind.

Cruising boats tend to be heavier, but better equipped than racing boats. They may have recognizable beds, but still with lee cloths to prevent falls.

Dampness due to the saltwater environment and humidity is ever-present. Damp bedding has decreased insulation and is less pleasant to sleep in and crew should take any opportunity to dry it thoroughly.

Patience and tolerance are essential if the crew are to remain happy and efficient. When in close proximity, noises and smells must be tolerated by the observer, and minimized by the emitter.

Eating at sea is a communal activity. Personal choice is reduced with less opportunity for ‘grazing’ or indulgences, food supplies must take into account personal dietary restrictions. Occasional treats may prevent mutiny.