CPR & First Aid Licensing Requirements
The USCG requires valid first aid and CPR certifications for all OUPV and Master license applicants. These must be current at the time of application.
What the USCG Requires
- ▸Current First Aid certificate from an approved provider
- ▸Current CPR certificate (adult CPR at minimum)
- ▸Combined CPR/First Aid courses satisfy both requirements
- ▸Must be valid (not expired) at time of application submission
- ▸STCW Basic Safety Training (BST) satisfies this requirement for international tonnage vessels
Approved Providers
- ▸American Red Cross
- ▸American Heart Association
- ▸National Safety Council
- ▸USCG-approved maritime training centers
- ▸YMCA / other nationally recognized organizations
Hypothermia — Stages, Signs & Treatment
Hypothermia is the most common cause of preventable death in cold-water environments. Know the three stages — the exam tests all of them.
Mild Hypothermia
90–95°F (32–35°C)Signs & Symptoms
- ▸Shivering (uncontrollable)
- ▸Numbness and tingling
- ▸Impaired coordination
- ▸Slurred speech
- ▸Confusion / poor judgment
Treatment
Move to warm environment, remove wet clothing, insulate with blankets, give warm beverages if conscious and alert.
Moderate Hypothermia
82–90°F (28–32°C)Signs & Symptoms
- ▸Shivering STOPS (danger sign)
- ▸Muscle rigidity
- ▸Severe confusion / lethargy
- ▸Bradycardia (slow pulse)
- ▸Pupils dilate
Treatment
Handle gently — avoid rough movement. Apply external heat to neck, armpits, groin (warm compresses). Do not rub extremities. Horizontal position.
Severe Hypothermia
Below 82°F (28°C)Signs & Symptoms
- ▸Unconsciousness
- ▸Fixed dilated pupils
- ▸No detectable pulse
- ▸Cardiac arrhythmias / fibrillation
- ▸Resembles death
Treatment
Begin CPR if no pulse. Do NOT assume death until patient is warm. Arrange immediate MEDEVAC. Avoid shock to the chest — can trigger VF.
Critical Rule — "Not Dead Until Warm and Dead"
A severely hypothermic patient may have no detectable pulse, no breathing, and fixed dilated pupils — and still be resuscitable. Do not stop CPR until the patient's core temperature has been raised. Hospital rewarming with cardiac bypass has revived patients with core temperatures below 65°F (18°C).
Heat Exhaustion vs. Heat Stroke
Heat Exhaustion
Urgent- ▸Heavy sweating — skin is cool and moist
- ▸Weakness, fatigue, muscle cramps
- ▸Nausea, headache, dizziness
- ▸Normal or slightly elevated temperature
- ▸Patient is conscious and alert
Treatment
Move to shade or cool area. Loosen clothing. Apply cool wet cloths. Give cool water or electrolyte drinks if conscious. Rest. Monitor for progression to heat stroke.
Heat Stroke
EMERGENCY- !Hot, DRY skin — sweating has stopped
- !Temperature above 104°F (40°C)
- !Confusion, disorientation, altered mental status
- !Possible seizures or unconsciousness
- !Rapid strong pulse, then weakening
Treatment — Act Immediately
Cool by ANY means: wet towels, ice packs to neck/armpits/groin, cool water dousing, fan. Do NOT give fluids to an unconscious patient. Arrange MEDEVAC immediately — this is a brain and organ emergency.
Drowning & Near-Drowning Treatment
Immediate Steps
Remove from water
Get the victim out safely — do not put yourself at risk without equipment or backup.
Check ABCs
Airway, breathing, circulation. Open airway with head-tilt chin-lift. Look, listen, feel.
Begin CPR if not breathing
Do NOT delay CPR to drain water from the lungs. Start rescue breaths and compressions immediately.
Treat for hypothermia
Remove wet clothing, insulate. Water conducts heat away 25x faster than air — hypothermia is likely even in warm water.
Arrange MEDEVAC
All near-drowning victims require hospital evaluation even if they appear to recover. Secondary drowning can occur 1–24 hours later.
Secondary Drowning — Critical Warning
A victim who appears to recover fully after a near-drowning event may still die hours later from fluid accumulation in the lungs (pulmonary edema). This is called secondary (or delayed) drowning.
- ▸Watch for: coughing, shortness of breath, fatigue, chest pain hours after the event
- ▸Any near-drowning victim should be transported to a medical facility regardless of apparent recovery
- ▸"Walks off the dock fine" is not a discharge criterion
Spinal Precautions
If there is any mechanism for spinal injury (diving accident, boat collision, fall from height), immobilize the spine before and during extraction from the water. Use a backboard if available. Keep the patient horizontal and avoid twisting the head or neck.
Seasickness Management
Prevention
- ▸Antihistamines (meclizine/Dramamine) taken 1–2 hours before departure
- ▸Scopolamine patch — apply behind ear 4 hours before departure
- ▸Stay on deck — fresh air, fix eyes on the horizon
- ▸Avoid alcohol, heavy meals, and strong odors
- ▸Ginger supplements or ginger ale — mild benefit
Treatment Aboard
- ▸Position at the vessel's center of motion (near amidships, low)
- ▸Lie down with eyes closed if unable to watch horizon
- ▸Sip clear fluids to prevent dehydration
- ▸Promethazine (Phenergan) — IM injection if oral route fails
- ▸Rest and avoid reading or looking below deck
When to Escalate
- ▸Severe dehydration — unable to keep any fluids down
- ▸IV fluids may be necessary if prolonged vomiting
- ▸Incapacitated crew member affects vessel safety — consider diverting
- ▸Distinguish seasickness from other causes (appendicitis, cardiac event)
- ▸Arrange port entry or MEDEVAC if patient cannot be stabilized
Shock — Recognition & Treatment
Signs & Symptoms
| Assessment | Finding in Shock |
|---|---|
| Pulse | Rapid, weak, thready |
| Skin | Pale, cool, clammy |
| Breathing | Rapid, shallow |
| Mental status | Confused, anxious, restless |
| Pupils | Dilated |
| Blood pressure | Low or falling |
| Urination | Decreased or absent |
| Nausea / vomiting | Common |
Shock Treatment Protocol
Treat ALL trauma patients for shock
Do not wait for vital sign changes. By the time blood pressure drops, the patient has lost up to 30% of blood volume. Treat early and aggressively.
Burns — Classification & Treatment
1st Degree
SuperficialAppearance
Redness, dry skin, no blisters
Pain Level
Painful
Treatment
Cool with water (not ice). Cover lightly. No butter or ointments.
2nd Degree
Partial ThicknessMEDEVAC: Large area (>10% body) or face/hands/feet/jointsAppearance
Blisters, moist pink/red, severe pain
Pain Level
Very painful
Treatment
Cool with water. Cover loosely with sterile dressing. Do NOT pop blisters. Treat for shock if large area.
3rd Degree
Full ThicknessMEDEVAC RequiredAppearance
White, brown, or charred. Dry, leathery. Painless at site.
Pain Level
Painless (nerve damage)
Treatment
Do NOT apply water. Cover loosely with dry sterile dressing. Treat for shock. MEDEVAC immediately.
Burns Always Requiring MEDEVAC
- ▸Burns to face, hands, feet, genitalia, or major joints
- ▸Circumferential burns (ring around a limb) — circulation risk
- ▸Inhalation burns (singed nasal hairs, hoarse voice, soot in mouth)
- ▸All electrical burns — internal damage always exceeds external
- ▸Chemical burns — continue irrigating with water during transport
- ▸Burns in children or elderly — smaller area = greater risk
What NOT to Do
- ✗Do NOT apply butter, oil, or ointments to burns
- ✗Do NOT use ice — causes vasoconstriction, worsens tissue damage
- ✗Do NOT pop blisters — they are sterile wound coverings
- ✗Do NOT remove clothing stuck to a 3rd-degree burn
- ✗Do NOT apply water to 3rd-degree burns (increases shock risk)
Fractures & Dislocations at Sea
Signs of a Fracture
- ▸Pain at the injury site, especially with pressure or movement
- ▸Swelling and bruising
- ▸Deformity — abnormal angulation or shortening of a limb
- ▸Inability to bear weight or use the limb normally
- ▸Crepitation (grinding sensation) with movement
- !Open fracture: bone visible through skin — treat as contaminated wound
Splinting Principles
- ▸Splint the limb in the position found — do not attempt to straighten
- ▸Immobilize the joint above AND below the fracture site
- ▸Check circulation: pulse, sensation, and movement distal to the injury
- ▸Pad all bony prominences under the splint
- ▸Monitor for swelling — loosen if circulation is compromised
Dislocations
A dislocation is when a bone is forced out of its joint. Common maritime injuries: shoulder, finger, ankle. Signs: joint deformity, severe pain, complete loss of normal range of motion.
Spinal Injuries — Critical
Suspect spinal injury after any fall from height, diving accident, collision, or high-energy impact. Signs: neck or back pain, numbness or tingling in extremities, weakness, paralysis.
- !Do NOT move patient without spinal immobilization
- !Log-roll technique if movement is necessary
- !Arrange MEDEVAC — do not transport by boat if avoidable
Allergic Reactions & Anaphylaxis
Progression of Allergic Reactions
Mild
Hives, itching, redness, runny nose
Oral antihistamine (diphenhydramine / Benadryl). Monitor closely.
Moderate
Swelling of lips or tongue, abdominal cramping, vomiting
Antihistamine + consider epinephrine. Watch airway carefully. MEDEVAC standby.
Severe (Anaphylaxis)
Throat swelling, stridor, difficulty breathing, low BP, loss of consciousness
EPINEPHRINE NOW. Lay flat. Oxygen. MAYDAY for MEDEVAC.
Epinephrine (EpiPen) Protocol
Remove EpiPen from carrier and pull off safety cap
Place tip against outer thigh — can inject through clothing
Press firmly and hold for 10 seconds
Remove and massage injection site for 10 seconds
Lay patient flat with legs elevated (if not breathing difficulty)
Administer second dose after 5–15 min if no improvement
Call MAYDAY — epinephrine wears off; hospital care required
Chest Pain & Heart Attack at Sea
Signs & Symptoms
- !Crushing, pressure, or squeezing chest pain — "elephant on chest"
- !Pain radiating to left arm, jaw, neck, shoulder, or back
- !Shortness of breath
- !Nausea, vomiting, profuse sweating
- !Pale skin, anxiety, sense of impending doom
- !Atypical (women/diabetics): fatigue, back pain, nausea without chest pain — still consider cardiac
Immediate Treatment
Keep patient calm — rest, no exertion of any kind
Position sitting upright or semi-reclined (aids breathing)
Aspirin 325 mg chewed — if not allergic and no contraindications (major bleeding)
Supplemental oxygen if available
Call MAYDAY — cardiac emergencies are time-critical. 'Time is muscle.'
Prepare to start CPR — have an AED ready if carried aboard
MEDEVAC — Medical Evacuation Procedures
How to Request MEDEVAC via Coast Guard
Transmit a MAYDAY on VHF Channel 16. Provide all information clearly and calmly.
MEDEVAC Hoist Operations — Captain's Duties
- ▸Head into the wind at minimum speed (creates stable relative wind for helicopter)
- ▸Clear the deck of loose gear, lines, and antennas if possible
- ▸Do NOT touch the rescue basket or swimmer until static discharge touches the deck or water first — electrical static build-up can be severe
- ▸Do NOT attach hoist cable to the vessel — the helo must be able to fly away at any moment
- ▸Communicate with rescue coordination on Ch 16 or 22A as directed
- ▸Mark position with smoke flare if directed — deploy downwind of vessel
MEDEVAC Decision Criteria
Arrange MEDEVAC when the patient has any of the following:
- !Cardiac arrest, chest pain, or arrhythmia
- !Respiratory failure or airway compromise
- !Uncontrolled hemorrhage or severe shock
- !Altered mental status or unconsciousness
- !Severe hypothermia (below 90°F core)
- !Anaphylaxis or severe allergic reaction
- !Major trauma — fracture, burn, spinal injury
TRIAGE Principles for Multiple Casualties
When multiple people are injured simultaneously, triage prioritizes who receives care first based on survivability and urgency — not who is loudest or most visible.
IMMEDIATE
(Red)Life-threatening injuries survivable with rapid intervention.
Airway obstruction, major hemorrhage, tension pneumothorax, unconscious with breathing.
DELAYED
(Yellow)Serious injuries that can safely wait minutes to hours.
Stable fractures, burns without airway involvement, back injuries without paralysis.
MINOR
(Green)Walking wounded — minor injuries, can self-rescue.
Minor lacerations, sprains, mild burns, minor fractures.
EXPECTANT
(Black)Injuries incompatible with survival given available resources, or deceased.
Cardiac arrest with multiple casualties, unsurvivable injuries.
Triage at Sea — Practical Considerations
- ▸Perform a rapid walk-through: assess all casualties before treating any one person
- ▸Airway, breathing, hemorrhage control: always first regardless of tag
- ▸Reassess triage categories as conditions change
- ▸Use all available crew — delegate clearly (one person per task)
- ▸The loudly screaming patient is usually NOT the most critical (they have an airway)
- ▸Unconscious patients who are breathing — position them in the recovery position
- ▸Communicate with USCG — they can provide medical advice via radio (MEDICO)
- ▸Document all treatments rendered and timestamps for handoff to medics
Exam Tips — What the USCG Tests
CPR + First Aid = both required
The exam and the NMC application require both a first aid certificate AND a CPR certificate. Know the specific names of acceptable providers (ARC, AHA, NSC). Combined courses satisfy both.
Heat stroke skin is DRY — not sweaty
Exam questions use this as the key differentiator. Heat exhaustion = sweating, cool skin. Heat stroke = NO sweating, hot skin, altered mental status. If skin is dry and hot, it is heat stroke.
Shivering stops in moderate hypothermia — danger sign
When a hypothermic patient stops shivering, that is NOT improvement — it means the body's last defense mechanism has failed. Core temperature has dropped into the moderate range.
Never assume death in hypothermia
'Not dead until warm and dead' is a real emergency medicine principle. Severe hypothermia mimics death. Start CPR, arrange MEDEVAC, and let hospital professionals declare death if rewarming fails.
All near-drowning = hospital evaluation
Secondary drowning can kill a victim who seemed fine after rescue. Exam questions will test whether you know all near-drowning victims require medical evaluation — including those who appear fully recovered.
Static discharge before touching hoist basket
Let the rescue basket or cable touch the deck or water before touching it. Helicopters build up massive static electricity charge. Grabbing the basket before grounding can cause severe injury.
Frequently Asked Questions
What first aid and CPR certifications are required for a USCG captain's license?
For an OUPV (6-Pack) or Master license, USCG regulations require a current first aid certificate and a current CPR certificate (or a combined CPR/first aid course). Both must be issued by a recognized provider such as the American Red Cross, American Heart Association, or USCG-approved equivalent. The certificates must be valid at the time of application. Some courses approved for STCW also satisfy this requirement.
What are the three stages of hypothermia and their signs?
Mild hypothermia (core temp 90–95°F / 32–35°C): shivering, numbness, impaired coordination, slurred speech, confusion. Moderate hypothermia (82–90°F / 28–32°C): shivering stops (a critical danger sign), muscle rigidity, severe confusion, drowsiness, slow pulse. Severe hypothermia (below 82°F / 28°C): unconsciousness, cardiac arrhythmias, no detectable pulse, fixed dilated pupils. A person in severe hypothermia may appear dead — do not assume death until the patient is warm and dead. Begin CPR if no pulse is detected.
What is the difference between heat exhaustion and heat stroke?
Heat exhaustion: heavy sweating, cool moist skin, weakness, nausea, headache, dizziness, normal or slightly elevated temperature. The patient is alert. Treatment: move to shade, cool environment, give fluids if conscious, loosen clothing. Heat stroke (medical emergency): hot DRY skin, temperature above 104°F (40°C), confusion, altered mental status, possible unconsciousness — sweating stops. This is a life-threatening emergency. Cool immediately by any means available (wet towels, ice, cool water dousing), fan, call for MEDEVAC. Do not give fluids to an unconscious patient.
How do you treat a near-drowning victim on board?
Remove the victim from the water immediately. Check responsiveness, breathing, and pulse. Begin CPR if the patient is not breathing — do not delay to drain water from the lungs. Even if the patient initially appears to breathe normally, near-drowning can cause delayed pulmonary edema (secondary drowning) hours later. Keep the patient warm, as hypothermia often accompanies drowning. All near-drowning victims — even those who appear to recover fully — require evaluation at a medical facility. Arrange MEDEVAC or immediate transport to a hospital.
How do you recognize and treat shock at sea?
Signs of shock: rapid weak pulse, pale cool clammy skin, rapid shallow breathing, confusion or altered mental status, nausea, dilated pupils, low or falling blood pressure. Treat all major trauma patients for shock regardless of current vital signs. Treatment: lay the patient flat and elevate legs 8–12 inches if no spinal injury is suspected; keep warm; control bleeding; do not give food or fluids by mouth; provide supplemental oxygen if available; arrange immediate MEDEVAC. Shock is a progressive emergency — untreated, it is fatal.
What MEDEVAC radio procedure should a captain use when requesting medical evacuation?
Transmit a MAYDAY on VHF Channel 16 to the Coast Guard. Provide: vessel name and call sign, position (lat/lon or bearing/distance from a known point), nature of the medical emergency, patient's age, sex, symptoms, and current condition, number of persons on board, vessel description. The USCG will coordinate with USCG Sector to arrange a rescue helicopter, station boat, or redirect a nearby vessel. After initial contact, they may direct you to Channel 22A for working communications. In offshore areas, a MAYDAY via EPIRB or Inmarsat satellite may be used if VHF range is insufficient.
What are the TRIAGE priority categories and how are they assigned at sea?
TRIAGE (Sort, Assess, Lifesaving Interventions, Treatment/Transport) uses color tags: Immediate (Red) — life-threatening but survivable with rapid intervention; Delayed (Yellow) — serious injuries that can wait minutes to hours; Minor (Green) — walking wounded, minor injuries; Expectant (Black) — injuries incompatible with survival given resources available, or deceased. At sea, with limited resources, apply triage to prioritize who receives care first when you have multiple casualties. Airway, breathing, and severe hemorrhage control are always first priorities regardless of category.
How do you treat anaphylaxis (severe allergic reaction) on a vessel?
Anaphylaxis signs: hives, swelling (especially face, throat), difficulty breathing, stridor, low blood pressure, rapid weak pulse, loss of consciousness. This is immediately life-threatening. Epinephrine (EpiPen) is the primary treatment — inject in the outer thigh, even through clothing, at the first sign of respiratory compromise or circulatory collapse. Lay the patient flat with legs elevated if in shock. Administer supplemental oxygen if available. Call for immediate MEDEVAC — epinephrine wears off and symptoms can return. All anaphylaxis cases require hospital evaluation.
How are burns classified and treated at sea?
First-degree (superficial): redness, pain, no blisters — treat with cool water, do not use ice. Second-degree (partial thickness): blisters, severe pain, moist appearance — cool with water, cover loosely, do not pop blisters. Third-degree (full thickness): white, brown, or charred skin, painless at the site (nerve damage), dry leathery appearance — cover loosely with dry sterile dressing, do not apply water, treat for shock, arrange MEDEVAC. Never apply butter, oil, or ointments. Electrical burns may appear minor externally but cause massive internal damage — always arrange MEDEVAC. Burns to face, hands, feet, genitalia, or joints, and circumferential burns, are always serious.
What are the signs of a heart attack and how should a captain respond?
Signs: crushing chest pain or pressure (may radiate to left arm, jaw, neck, or back), shortness of breath, nausea, sweating, pale skin, sense of impending doom. Some patients — especially women and diabetics — present with atypical symptoms (fatigue, back pain, nausea without chest pain). Immediate actions: keep the patient calm and at rest (sitting up if it helps breathing), administer aspirin (325 mg chewed if not allergic and no contraindications), give supplemental oxygen if available, arrange MEDEVAC immediately — cardiac emergencies are time-critical. Be prepared to begin CPR if the patient loses consciousness and has no pulse.
Related Study Guides
Man Overboard Procedures
Williamson Turn, Anderson Turn, Pan-Pan calls, hypothermia survival times, and victim recovery.
VHF Marine Radio Guide
Channel assignments, MAYDAY procedure, DSC, and FCC licensing for the OUPV exam.
Deck General Safety
Fire classes, PFDs, EPIRB, stability, MARPOL, and all distress equipment.
Practice Medical Emergency Questions
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