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Path 3 — Medical & first response
Medical emergencies aboard
Module 3.412 minRecognition & crew role5-question check
Module 3.4
Beyond the water — medical needs aboard

Survivors coming aboard from a Mediterranean crossing carry a medical burden that goes far beyond exposure and drowning risk. Traumatic injuries, untreated long-term conditions, emergencies of pregnancy and childbirth, serious infection (sepsis) from untreated wounds, seizures from severe dehydration — all of these occur regularly on humanitarian SAR vessels. Crew members who can recognise the warning signs, alert the medical team rapidly, and provide calm support make a material difference.

This module is not first aid training. It is orientation to the most common emergencies your medical team will face, and your role in each. The conditions covered here represent what operational SAR organisations report encountering most frequently.

Clinical care is the medical team's responsibility
This module does not train you to diagnose or treat medical conditions. It helps you recognise warning signs, respond appropriately, and support the medical team effectively. If in doubt about any survivor's condition: alert the medical team and step back. Do not delay by trying to assess yourself.
What you'll cover
  • The most common medical conditions encountered in Mediterranean SAR
  • What to look for — warning signs for each condition
  • What crew should do — and what to avoid — for each
  • How to give a useful handover to the medical team
  • Mass casualty situations — when the system is under pressure
Estimated time
12 minutes — followed by a knowledge check
Section 1 of 2
Conditions you may encounter

Click each condition to expand. These are the most commonly reported medical presentations on humanitarian SAR vessels in the Central Mediterranean.

The overall picture
Most people embark tired with a degree of exposure but are generally medically stable. They need supportive care from the team but commonly recover without specific medical intervention. In the days that follow, you will typically see a degree of health-seeking behaviour — people who haven't had access to medical care for prolonged periods presenting with untreated conditions, including minor complaints wanting full evaluation. This can also be an indicator of more sensitive complaints — psychological or physical — that people are not yet feeling able to disclose.
Seasickness
Very common
What to look for
Nausea, vomiting, pallor, sweating, dizziness, fatigue. Can range from mild discomfort to complete incapacitation. Common in crew as well as survivors, particularly in rough conditions or during prolonged operations.
Context
Survivors crossing on overcrowded, unstable boats are particularly vulnerable — fear, exhaustion, dehydration, and the motion of the sea all compound seasickness. It is rarely dangerous on its own but worsens dehydration and can mask other conditions. It is also very common among new crew members.
Crew role
Conservative measures: encourage the person to look at the horizon, sit in fresh air, eat something small if able. Alert the medical team — they can offer medication. Ensure the person stays hydrated. Do not dismiss it as trivial if combined with other symptoms.
Exhaustion
By far the most common
What to look for
Profound fatigue. Inability to stand or move independently. Glazed or unresponsive appearance. Slowed speech. Collapse on boarding. Many survivors have not slept for 24 hours or more and have been physically and psychologically exhausted long before the crossing.
Context
Exhaustion is the baseline presentation for most people coming aboard. It does not indicate medical emergency on its own, but it masks other conditions — a person who is exhausted may not be able to communicate pain, distress, or deterioration. Treat exhaustion as a reason to look more carefully, not less.
Crew role
Provide a safe place to sit or lie. Maintain warmth. Offer water once directed by the medical team. Keep the area calm. Alert the medical team if the person is non-responsive or deteriorating.
Dehydration
Very common
What to look for — mild to moderate
Dry mouth and lips. Headache. Dizziness on standing. Dark urine. Fatigue and muscle cramps. Reduced alertness. These signs are present in the majority of survivors on Mediterranean crossings.
What to look for — severe
Sunken eyes. Skin that remains "tented" when pinched. Confusion or disorientation. Rapid weak pulse. Absent urine. In severe cases, seizures. Severe presentations require immediate medical assessment.
Context
Survivors may not have had water for 24–48 hours or more. Overcrowding, heat, sea sickness, and fear all accelerate fluid loss. Children and infants deteriorate much faster than adults. Relative dehydration is near-universal on arrival — the clinical question is severity.
Crew role
Alert the medical team. Ensure the person is seated or lying down safely. Do not give water until the medical team directs — in severe cases, oral fluids can cause complications. Keep the person calm and shaded.
Fuel burns (chemical burns)
Common / urgent
What to look for
Sitting in fuel and seawater mixture on a overcrowded boat causes chemical burns to the buttocks, groin, and lower limbs. Raw, red, or blistered skin in these areas. Survivors may be sitting on the fuel burns without realising the severity.
Context
Fuel burns are extremely common — almost endemic in boat-based crossings. The mixture of fuel, saltwater, and prolonged contact causes significant chemical burns. Fuel burns frequently present as a mass casualty incident, requiring multiple crew members to help organise shower and wound irrigation stations — the order and priority of treatment is decided by the medical team. If a survivor with burns can walk, allow them to do so.
Crew role
Alert the medical team if you observe signs of burns. Assist survivors to a position that avoids pressure on affected areas. Do not remove clothing over suspected burns without medical direction — clothing may be adhered to the wound.
Obstetric emergencies
Urgent
What to look for
Active labour (contractions, distress, waters may have broken). Postpartum haemorrhage — significant blood loss after recent delivery. Miscarriage in progress. Survivors may conceal pregnancy out of fear. Assess all women of reproductive age.
Context
Pregnant women are among the most common vulnerable persons on Mediterranean crossings. Deliveries aboard SAR vessels occur regularly. Stress, dehydration, and the physical conditions of crossing can precipitate early labour.
Crew role
Alert the medical team immediately. Ensure privacy for the individual as far as possible. Keep the area clear of non-essential personnel. Do not attempt to assess or assist without medical direction. Maintain calm around the person.
Seizures
Urgent
What to look for
Uncontrolled muscle convulsions. Loss of consciousness. Stiffening of limbs, then rhythmic jerking. Possibly biting tongue. Post-seizure confusion. Seizures in the SAR context are frequently caused by severe dehydration, heat stroke, or electrolyte imbalance — not necessarily pre-existing epilepsy.
Context
Electrolyte depletion — particularly sodium and potassium — from prolonged dehydration can cause seizures even in otherwise healthy people. Severe dehydration seizures are common and dangerous.
Crew role
Alert the medical team immediately. Clear the area around the person — remove hard objects. Do not hold the person down or restrain the convulsions. Do not put anything in their mouth. Time the seizure if possible. Stay with them. Alert if another seizure follows.
Psychogenic non-epileptic seizures (PNES)
One of the more common seizure presentations on SAR vessels is psychogenic non-epileptic — sometimes called a pseudo-seizure. These look like epileptic seizures but have a psychological rather than neurological cause. They are not faked. The crew response is identical: clear the area, do not restrain, alert the medical team immediately. The medical team will manage the differences in assessment and aftercare.
Traumatic injuries
Common
What to look for
Lacerations and puncture wounds (frequently infected from days of exposure). Fractures — often unreported because survivors do not seek to draw attention. Head injuries. Burns from friction on the boat or rope injuries from departure.
Context
Departure from crowded beaches or rocky coastlines in darkness causes injuries that go unaddressed for the entire crossing. Infected wounds on arrival may have been present for 48+ hours. Survivors often conceal injuries to avoid being separated from their group.
Crew role
Encourage survivors to report pain or injuries during initial reception — via interpreters if available. Do not probe wounds or remove embedded objects. Apply gentle pressure to actively bleeding wounds only if medics are occupied and the bleeding is significant. Alert the medical team.
Mental health crises
Common
What to look for
Acute distress, panic, dissociation (appearing "absent" or not responding normally). Aggressive or agitated behaviour. Catatonia — unresponsive and immobile while conscious. Loss of touch with surroundings. These responses may emerge suddenly and can be alarming but are normal reactions to extreme stress.
Context
Many survivors have experienced violence, detention, loss of family members, and the extreme fear of the crossing itself. The intensity of arrival on a rescue vessel can trigger acute stress responses. This is not a psychiatric disorder — it is a normal human response to abnormal events.
Crew role
Remain calm. Do not crowd the person or raise your voice. Speak quietly and slowly. Alert the medical team and any cultural mediator available. Give the person space but stay close enough to monitor. Psychological First Aid principles from module 3.5 apply here.
Fuel inhalation
Urgent — potential MCI
What to look for
Headache, dizziness, confusion, loss of consciousness, respiratory distress, irregular heartbeat, collapse. Symptoms may be delayed. Anyone who was on the lower deck of a wooden boat may have been exposed, even if they appear well on boarding.
Context
Fuel fumes accumulate on the lower decks of wooden boats — particularly when engines are running or fuel is leaking. Exposure can cause neurological, respiratory, and cardiovascular compromise. Deaths occur. This is also a significant risk for crew boarding or operating near the distress vessel — your vessel will have a specific SOP for this. Know it before you need it.
Crew role
Alert the medical team immediately. This may be a mass casualty incident — multiple people on the lower deck may be affected simultaneously. Follow your vessel's SOP for fuel inhalation. The medical team may ask for everyone from the lower deck to have their oxygen levels checked with a finger sensor (pulse oximetry), even those who appear well. Do not enter an enclosed fuel-contaminated space without appropriate protection.
Chronic untreated conditions
Common
What to look for
Survivors may be managing diabetes, hypertension, or other chronic conditions without medication — sometimes for months or years. Signs include confusion or disorientation (low blood sugar), high blood pressure presentations, or disclosure of a known condition without access to treatment.
Context
Many survivors have had no access to regular healthcare for prolonged periods. Chronic conditions may be undiagnosed, poorly managed, or actively worsening. Health-seeking behaviour in the days after rescue should be taken seriously — repeated presentations with minor complaints can indicate more significant underlying issues not yet disclosed.
Crew role
Alert the medical team to any disclosed chronic condition as early as possible. Do not give medications. Record what the person tells you if possible — even partial information is useful for the medical team.
Skin and hygiene-related conditions
Common
What to look for
Scabies (intense itching, rash between fingers, on wrists and abdomen). Skin infections and open sores. Urinary infections. Wound infections. These conditions often go untreated for prolonged periods in transit, worsening by the time of rescue.
Context
Overcrowded conditions in transit — detention facilities, informal camps, boats — create environments where skin conditions spread rapidly and infections go untreated. What presents as a minor complaint may have been developing for weeks or months.
Crew role
Alert the medical team. Follow any infection control protocols in place on your vessel — some conditions are contagious. Do not attempt to treat or clean wounds without medical direction.
Violence-related presentations
Handle with care
What to look for
Many survivors have experienced physical violence, psychological abuse, or sexual violence at some point in their journey — in their country of origin, in transit countries, or in Libya. These may present as visible physical injuries, acute psychological distress, extreme withdrawal, or may not be disclosed at all during initial reception.
Context
Violence in transit — particularly in Libya — is extensively documented. Beatings, torture, and sexual violence are common experiences. Survivors may be in acute shock, may minimise what they have experienced, or may disclose gradually over days. Initial reception is rarely the moment of full disclosure.
Crew role
Provide a safe, calm, non-judgmental presence. Alert the medical team. Do not ask questions about the person's journey or experiences — this is not your role and can cause harm. If a person discloses something to you, listen without pressing for more detail and without expressing shock or visible distress. Your role is presence and referral, not assessment.
Peri-rescue collapse
Urgent
What to look for
Sudden collapse or rapid deterioration in a survivor who appeared stable — often at or immediately after the point of rescue or boarding. Can present as fainting, loss of consciousness, seizure, or cardiovascular collapse. May occur in someone who appeared to be managing well moments before.
Context
When survivors see the rescue vessel approaching, the extreme psychological and physiological stress of the crossing begins to release. The sudden drop in adrenaline and the fight-or-flight response can cause rapid deterioration — a recognised and documented phenomenon sometimes called peri-rescue collapse. Do not be surprised if someone who was conscious and responsive during recovery suddenly collapses once they are aboard or near safety.
Crew role
Alert the medical team immediately. Keep the person horizontal and supported. Do not leave them unattended. This is not predictable or preventable — it is a physiological response to relief from extreme stress. Your role is to recognise it and get medical support as fast as possible.
Section 2 of 2
Your role in a medical emergency

When a medical emergency occurs aboard, crew often face the same dilemma: the instinct to help directly versus the practical reality that untrained intervention can worsen outcomes and obstruct the medical team's access. The most valuable thing a non-medical crew member can usually do is the following.

Alert fast

Get the medical team there immediately. Learn your vessel's alert protocol before operations begin. Know the call sign, channel, and location of the medical bay.

Clear space

Non-essential people around a medical patient impede care. Move other survivors away, keep the area clear, and ensure only those directed to assist by the medics remain nearby.

Observe and report

When you hand over to the medical team: tell them what you saw, when it started, any relevant context. "She has been unconscious for approximately 3 minutes, no visible injury" is useful. "She collapsed" is less useful.

Stay present

Do not walk away once the medical team arrives. Stay close enough to assist if asked — provide equipment, translate via cultural mediators, manage surrounding survivors, maintain situational awareness.

Giving a medical handover
Use SBAR structure if your organisation uses it: Situation — what is happening now. Background — relevant context (time in water, apparent age, what you observed before collapse). Assessment — what you think is going on (dehydration, seizure etc.) — be honest about uncertainty. Request — what you need from the medical team. A short clear SBAR takes 20 seconds and gives medics what they need to act immediately.
Under pressure — mass casualty situations
During a large rescue operation, the medical team will be managing multiple casualties simultaneously. In these situations, crew members may be asked to hold positions, apply basic support, manage large groups of survivors, or relay information between the triage area and the medical team. Your ability to follow direction calmly, communicate clearly, and remain focused makes the difference. Triage decisions are made by medical personnel. Do not question them in the moment.
Knowledge check
Before you move on

Five application-based questions on medical emergencies aboard.