Andrew Nathanson, MD, is an emergency physician at Rhode Island Hospital, USA, and has sailed for decades. He talks to YBW about the most common sailing injuries and how to avoid them.

Andrew Nathanson, MD, has been sailing since he was a child, and has spent many years researching sailing injuries – what causes them and what steps can be taken to prevent them.

Based in Bristol, Rhode Island, USA, he is an emergency physician at Rhode Island Hospital and The Miriam Hospital, and clinical professor of emergency medicine at the Alpert Medical School of Brown University.

He also runs a one-week course, MedSail BVI through the Wilderness Medical Society. The course teaches medicine applicable to sailors, such as injury prevention and emergency treatment.

Keep your eyes open

Nathanson says the most common type of injury are bruises, although, in many cases, emergency treatment isn’t needed.

Sailing injuries bruising

Bruises are the most common sailing injury. Credit: Wikimedia Commons

Unsurprisingly, tripping and falling are the most common ways sailors injure themselves on board.

In a survey conducted by Nathanson and his colleagues, 30% of all those interviewed on keel boats said the mechanism of their injury was falling or tripping.

These resulted in fractures, head injuries, falls overboard, and falls through open hatches.

“Prevention can include a ‘one hand for you, one hand for the ship’ strategy,” said Nathanson. “The ergonomics of boats can also be improved; there are lots of things to trip on as the design is for the boat and not for the human walking on deck.”

He said falls could be reduced by improved footwear, better anti-skid deck surfaces, less clutter and more ergonomic deck layouts.

“It is hard to change your boat, but if you look at modern racing yachts they have open decks, coffee grinder winches and crew store rope in pocket,” he added.

Nathanson suggested simple steps such as removing the spinnaker pole from the deck when its not in use and not leaving hatches open.

Be careful when handling the sheet

Getting caught in lines was the second most common mechanism of injury on board. It accounted for 28% of hand injuries, such as rope burn.

Finger injuries, fractures and lacerations can all be caused by incorrectly releasing line under tension.

Watch your head

Being hit by an object is responsible for around 21% of all injuries, and these most often occur during tacks and jibes, especially if it is unplanned in high winds.

“Crossing from the low to high side under the boom and getting hit by the boom; a lot of head injuries happen that way,” explained Nathanson.

He said this can be prevented by “making sure there is awareness and good communication before the manoeuvre.”

Protective head gear, padded spars, and higher boom clearance can also reduce impact injuries.

Heavy weather, fatigue and equipment failure are also a contributing factor.

“Situational awareness is also important, such as communicating to the crew that a manoeuvre is about to happen. This is another way to prevent head injuries,” he added.

Nathanson said this type of injury can often occur amongst inexperienced sailors, who are in the “wrong place at the wrong time”.

“Make sure you give a full briefing if a new person is on board, especially those who have never sailed or don’t sail often,” he advised. 

Another common cause of injury occurs when starting an outboard, with people being accidentally hit in the face or head.

Protect your back

Putting repetitive strain on your back and joints was also highlighted during the survey.

Winch use was the fourth most common mechanism of injury on a keel boat – responsible for around 8% of injuries reported.

“The ergonomics of winches means you are hunched over,” explained Nathanson.

Sailing injuries prevention einches

Use your whole body when using winches

“So, it is tough on your back. Generally, on big boats it is tough on your back and on small boats it is tough on your knees and thighs,” he said.

Strength training and improved technique are two ways to minimise the risk of injury.

“Use your whole body, not just your arms,” advised Nathanson. “Make sure your legs are firmly planted and you’re on the downhill part of the winch.”

Finger injuries, fractures and lacerations were also common from improper winch use, often when releasing sheets.

Finger and hand injuries are some of the most common sailing injuries which result in sailors seeking emergency treatment.

“When trimming, make sure fingers are clear so they don’t get caught. This is particularly common with electric winches as fingers can get caught between the sheet and the winch,” said Nathanson, who explained that injuries involving winches tend to be disproportionately bad.

“In terms of properly releasing a line from a winch, always pull straight up and make sure the sheet is not wrapped around anything or anyone,” he added.

Protect yourself from the sun

Sunburn was described by Nathanson as “chronic”.

“Sailors should really consider skin cancer risks. They need to sunscreen up, wear a hat. They need to seriously think about injury prevention,” he stressed.

Amongst the sailors surveyed, Nathanson found that 16% of them reporting having suffered from sunburn while sailing in the preceding 12 months.

The use of sunscreen was low, especially among sailors aged 30 or under.

Use a life jacket

One of the top reasons for fatal injuries is being swept overboard. Wearing a life jacket nearly doubles your chances of survival, according to Nathanson.

He recommends wearing a life jacket and/or harness when out on the water, especially when reefing a main or jibing, and at night and/or while sailing in heavy weather.

Nathanson believes life jacket use rates can be increased through education and by improving the comfort of jackets, as well as enforcing their use at regattas and sailing schools.

Statistically, most injuries on a keel boat occur in the cockpit because it is where people spend most of their time. On racing yachts, the most common place for an injury was the foredeck.