Pain in Paradise: Top 5 Onboard Medical Complaints

2 December 2008 By Paulo Alves, M.D.

It might come as a surprise, but the same ailments that plague you at home are the very ones that occur most frequently at sea – to you, your guests and your crewmates. The difference, of course, is lack of proximity to traditional sources of medical care.

The key to effectively managing these ailments is actually quite simple: preparation. The first step is to ensure your vessel is equipped with the medical-safety trinity: (1) the proper medical kits and equipment; (2) a crew trained to recognize and manage onboard medical emergencies and (3) a reputable telemedicine service provider.

The next step is to understand the nature of onboard injuries and illness. While the ailments that occur most frequently aboard yachts tend to be less threatening, they're actually the very events that require the assessment skills of a medical professional.

Musculoskeletal Pain/Injury: Yacht crew are active – pushing, pulling and lifting and hefting objects daily. The final result can be back strain, pulled muscles and localized pain. Your guests may also suffer similar injuries due to physically demanding leisure activities that they may not be entirely fit to perform. In tending to a fellow crewmember or guest with such complaints, you can help the telemedicine doctor with his assessment by asking a series of questions: What is the pain level? Is it dull, sharp, stabbing, continuous or intermittent? When and why did the pain start? This allows the doctor to suggest treatment and recommend items from your onboard medical kit – which will often include a pain killer, muscle relaxant or anti-inflammatory drug. Your contact with a land-based medical professional is vital since musculoskeletal conditions often mimic more serious problems such as kidney stones, and sometimes even heart attack.

Acute Bronchitis: Bronchial inflammation can be caused by different agents such as viruses, bacteria and allergies. People cruising at sea often are exposed to a sudden variation in temperature that can predispose them to various respiratory problems. The telemedicine doctor will want to know if a fever or respiratory secretions are present as he makes a diagnostic impression. He may suggest medications, such as over-the-counter cough suppressants, prescription drugs to treat fever or antibiotics in cases where bacterial infection is suspected.

Rash: Skin rashes are generally related to allergic reactions but might also be a manifestation of serious infectious diseases such as rubella, measles and even bacterial meningitis. Some substances could promote skin reactions when taken orally when the person is exposed to sunlight, resulting in a phenomenon known as photosensitivity. Crew should be able to relay to the doctor useful information such as the presence/absence of itching or pain; the patchiness or homogeneity of the rash; whether sun-exposed areas are those affected; other symptoms present (fever, diarrhea, malaise) and if the rash is changing in location or shape.

Ear Pain: The changing pressure associated with diving imposes a burden to the middle ear, which is enhanced by pre-existing inflammatory conditions in the sinuses (sinusitis) or ear channel (otitis). Ear pain should be assessed by a medical professional before the individual undertakes further activities – particularly diving. Doctors will want to know how the symptoms started, and which factors relieve or worsen the pain. In many cases, after the initial recommendation, a subsequent medical exam will be required.

Nausea/Vomiting: In addition to the common complaint of motion sickness brought on by the rocking action of the yacht, food poisoning from the ingestion of toxins or microorganisms in food is another cause of nausea and vomiting. Because dehydration is the most feared complication and could be severe enough to cause death if not managed properly, crew should have the individual take small, frequent sips of water. A doctor also may recommend medicines from your onboard kits and in some cases oral or intravenous fluids, if necessary. Training regarding the risks of dehydration and techniques to prevent it should also be paramount to your vessel.

By understanding the most common medical incidents at sea and the role of a trained telemedicine provider, crew and guests alike can undertake their voyages with peace of mind.

Paulo Alves, M.D. is vice president, Medical Services, of MedAire, which provides full-service, 24-7 medical solutions for luxury yachts.