Position casualty; rescue and transport a casualty
Governing: STCW Table A-VI/1-3; Resuscitation Council UK 2025 First Aid guidelines (cervical spinal motion restriction). Builds on: L1.1.
Fractures and dislocations
Yachts produce falls down stairways and hatches, crush injuries in garages and on tender cradles, and impact injuries from jet skis and water toys.
Recognition
| Sign | Notes |
|---|---|
| Pain and tenderness | Worse on movement |
| Swelling and bruising | May develop over time |
| Deformity | Shortening, angulation, rotation |
| Loss of function | Cannot bear weight or use the limb |
| Grating (crepitus) | Do not test for it |
| Wound over the site | Open fracture: bone may be visible; bleeding and infection risk |
A dislocation looks similar at a joint. Do not try to put it back.
Management
- Support the injured part in the position found; let the casualty hold it if they can.
- Control bleeding from open fractures with pressure around, not on, protruding bone; cover with a sterile dressing.
- Immobilise the joints above and below the fracture: a sling for the arm, padding and bandaging a leg to the good leg, or a splint.
- Check circulation beyond the injury: colour, warmth, feeling. Loosen bandages if it worsens.
- Treat for shock (L2.3), especially with thigh or pelvic fractures, which can bleed heavily inside.
- Nothing by mouth.
Improvised splints: rolled towels, a rolled yoga mat, paddles, boat hooks, magazines, padded with clothing and secured with triangular bandages or straps.
CAUTION — Pelvis Suspect a pelvic fracture after a high-energy impact or a fall onto the hips. Do not rock or spring the pelvis. Keep the casualty still and flat; get help.
Spinal injury
RCUK 2025 advises suspecting a cervical spine injury after a fall or dive from a height, a crush by machinery or heavy object, or a road or sporting accident. On a yacht: falls from decks or ladders, diving off the swim platform into shallow water, and jet-ski collisions.
| Casualty | RCUK 2025 action |
|---|---|
| Awake and alert | Minimise neck movement; encourage them to hold their own neck still in a comfortable position. Never force position |
| Unresponsive, on back | Kneel behind the head and hold it in a neutral in-line position (head or trapezius squeeze). Consider a jaw thrust to open the airway |
| Unresponsive, face down | Check the airway; if it must be opened, log-roll as a unit with helpers, keeping the neck in line |
WARNING — Airway wins RCUK 2025 is clear: opening the airway always takes priority over in-line immobilisation. A casualty with a spinal injury who cannot breathe will die of the airway problem first.
Collars and spinal boards are for those with specialised training. Do not move a suspected spinal casualty unless there is danger, or the airway is threatened, for example by vomiting.
Rescue and transport
STCW expects you to be able to rescue and transport a casualty. On a yacht, that can mean up a steep ladder from the engine room, along narrow corridors, or from a tender.
| Method | Use |
|---|---|
| Drag (clothing or blanket) | Short distance out of danger |
| Two-person carry | Conscious casualty, short distance |
| Stretcher (rigid or scoop) | Longer moves, suspected fractures |
| Neil Robertson or basket stretcher | Vertical lifts through hatches and ladders |
| Rescue boat or tender | From water to deck |
Principles: plan the route first; enough people; one leader calls the moves; lift with legs, not back; secure the casualty to the stretcher; head uphill on stairs unless told otherwise.
TIP — Practise the route Carry a crew member on the stretcher from the engine room to the aft deck in a drill. Every yacht has a corner the stretcher will not get round.