B.1.3.1 Types of Yachting
B.1.3.2 Competitive sailing
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.
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 yacht racing has increased markedly over the latter half of the 20th 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.
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.
B.1.3.3 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.
B.1.3.4 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.
B.1.3.5 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.
B.1.3.6 The sailing environment
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?
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.
B.1.3.8 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.
B.1.3.9 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.
B.1.3.10 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.
B.1.3.11 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.