On the water, help is often further away than on land: there’s no ambulance arriving within minutes, only a radio call, a transit time, and sometimes a rescue boat that still has to get underway. That’s exactly why, in an emergency, every skipper is initially on their own. This article summarizes the first aid basics that matter most on board and how to respond correctly in the most common emergencies.

Why every skipper needs first aid knowledge

First aid isn’t a topic of its own in the SBF (Sportbootführerschein, the German powerboat/sailing license) written exam question catalogue, and unlike the medical fitness certificate, it isn’t a separate admission requirement either. That’s exactly why the topic often gets neglected during exam preparation, even though in real boating life it matters at least as much as navigation lights or right-of-way rules, since as skipper you’re responsible for your entire crew. If you’ve taken a first aid course before, you already know the basics, but a few things are different on board: motion, cold, wet conditions, and the fact that professional help doesn’t arrive within a few minutes.

Stay calm and assess the situation

The first step in any emergency isn’t treatment, it’s assessing the situation:

  • Protect yourself first: don’t put yourself in danger. A second casualty helps no one.
  • Secure the situation: get the engine out of harm’s way, stabilize the boat, and if possible assign other crew members clear tasks (calling for help, fetching equipment, taking the helm).
  • Check responsiveness: speak loudly to the person and gently shake their shoulders. If there’s no reaction, they’re unconscious.
  • Check breathing: carefully tilt the head back, clear the airway, and watch, listen, and feel for breathing movements for a few seconds.

This brief assessment determines which of the following measures is needed next.

Calling for help correctly

Once it’s clear that professional help is needed, the call for help takes priority over almost everything else:

  • By radio: the international distress and calling channel is VHF channel 16. A Mayday call includes the boat’s name, position, nature of the emergency, and the number of people on board.
  • By phone: in Germany, on both coastal and inland waters, you can also reach emergency services via the Europe-wide emergency number 112, provided you have mobile signal.
  • Give your position as precisely as possible: GPS coordinates, a chart reference, or distinctive landmarks help rescuers find you quickly.

For the other recognized distress signals and when you’re allowed to use them, see the article Distress Signals at Sea.

Recovery position and resuscitation

If a person is unconscious but breathing normally, place them in the recovery position: turn the body onto its side so the airway stays clear and any vomit or fluid can drain away without the person choking on it. The upper arm supports the torso, the upper leg is bent, and the head is tilted slightly back.

If the person isn’t breathing normally, immediate action is required:

  1. Call for help, ideally in parallel with treatment, through a second person if one is available.
  2. Start chest compressions: press hard and fast in the center of the chest, at a rate of about 100 to 120 compressions per minute and a depth of about 5 to 6 centimeters for adults.
  3. Add rescue breaths if trained to do so: alternate 30 compressions with 2 breaths, until professional help takes over or the person starts breathing normally again.
  4. If a defibrillator (AED) is on board or nearby, use it as early as possible, the device will guide you through its use with voice prompts.

Resuscitation is physically demanding, and it’s even harder on board due to the boat’s motion and limited space. Rotate with other crew members if possible to keep compression quality high. If you’re unsure or untrained in rescue breaths, continuous chest compressions without pausing for breaths are still far better than no help at all.

First aid for the most common emergencies on board

Man overboard and near-drowning

After a fall into the water, getting the person back on board safely comes first, we’ve described that maneuver itself in the article Man Overboard Maneuver. Once the person is back on board, check responsiveness and breathing as described above. Important: even if the person initially seems responsive, their condition can still worsen after a fall into cold water, so they should be monitored closely and, if in doubt, seen by a doctor.

Hypothermia

Cold water, or sustained wind and wet conditions, cool the body down faster than you’d expect. Signs include shivering, confusion, slowed reactions, and pale, cold skin. First measures:

  • Get the person out of the wind and wet, and replace wet clothing with dry clothing.
  • Insulate with blankets, sleeping bags, or extra clothing, paying particular attention to protecting the head and torso.
  • Rewarm carefully and slowly, avoid rough handling or massaging the limbs, which can strain circulation in severe hypothermia.
  • If conscious, offer warm, sugary drinks, never alcohol.
  • For severe hypothermia or unconsciousness: call for help and keep the person warm and still until rescuers arrive.

Seasickness

Unpleasant but rarely dangerous: nausea, dizziness, and vomiting caused by the boat’s motion. It helps to get fresh air, look at the horizon or the shore, find a calm spot near the boat’s center of motion, and drink enough fluids. Anyone prone to seasickness should take preventive medication well before departure, since it works considerably less well once symptoms have already started.

Heatstroke and sunstroke

Prolonged sun exposure and heat on deck can quickly lead to headaches, nausea, a flushed face, or drowsiness. Move the person into shade immediately, cool the head and neck, provide fluids, and loosen tight clothing. If symptoms keep worsening, body temperature stays high, or consciousness becomes impaired, call for help.

Cuts, bruises, and burns

Most minor injuries on board happen with lines, winches, hatches, or the engine:

  • Bleeding wounds: apply firm pressure with a clean cloth or dressing, and elevate the injured area if possible.
  • Bruises and impact injuries: cool and immobilize the area; with severe pain or visible deformity, consider a possible fracture and avoid putting weight on it.
  • Burns, for example from a hot engine: cool immediately with lukewarm water, don’t use home remedies like butter or flour, and cover the wound loosely with a sterile dressing.

Choking

If someone gets a piece of food stuck in their windpipe, they may suddenly be unable to speak or cough and often clutch at their throat. If they can still cough forcefully, that’s their most effective reflex, let them keep coughing. If that stops working:

  1. Lean the person’s upper body forward and give up to five firm blows between the shoulder blades.
  2. If that doesn’t help, apply up to five abdominal thrusts (the Heimlich maneuver) from behind: wrap your arms around the person’s torso, place a fist just above the navel, and pull sharply inward and upward.
  3. Keep alternating back blows and abdominal thrusts until the obstruction clears or professional help takes over.
  4. If the person becomes unconscious during this, start chest compressions immediately as described above and call for help.

First aid equipment on board

A well-stocked, waterproof first aid kit belongs on every boat, whether or not one is specifically mandated for your type of boat and cruising area. It should include sterile compresses and adhesive dressings in various sizes, a triangular bandage, disposable gloves, an emergency blanket, bandage scissors, and, if useful, seasickness medication. It’s worth checking the contents regularly for completeness and expiry dates, and making sure every crew member knows where the kit is stowed, because in a real emergency every second spent searching counts. If you’re out on the water regularly, it’s also worth refreshing your own first aid training from time to time, plenty of skills fade surprisingly fast if you don’t practice them.

Preparation is the best first aid

The most effective first aid measure is the one you never end up needing. A short safety briefing for the crew before casting off belongs on every boat: where the first aid kit is, where the life jackets are stowed, how the life raft or dinghy works, and who takes on which task in an emergency. Properly fitting life jackets for crew and guests are the single most important piece of preventive equipment, which buoyancy class suits which use is covered in the article Choosing the Right Life Jacket. Once you’ve walked through these points, you’ll react noticeably calmer and faster in a real emergency, because nobody has to search or figure things out on the spot.

First aid training itself isn’t part of the written exam content, but you can specifically train the actual exam questions on safety on board, distress signals, and correct behavior in emergencies using the official ELWIS question catalogue in the Boatpass app, covering both SBF Inland and SBF Coastal.

Handing over to the rescue services

When a rescue boat, helicopter, or paramedics arrive on scene, a short, clear handover makes a real difference to further treatment: what happened and when, which measures have already been taken, and any known pre-existing conditions or allergies. Stay with the person until the handover is complete, and keep watching them for signs of deterioration, such as shock, even after a situation that seemed to be over. When in doubt, it’s always better to call emergency services or see a doctor one time too many than to underestimate a serious injury.

Conclusion

First aid on board follows the same basic principles as on land, but comes with a few extra challenges: less space, motion, cold, and wet conditions, and help that takes longer to arrive than you’re used to. If you’re confident in protecting yourself, calling for help, the recovery position, and the basics of resuscitation, and can recognize common on-board emergencies like hypothermia, seasickness, or burns, you’ll be able to bridge those critical first minutes until professional help takes over.