Background At any time, thousands of people are at sea around the UK. We wished to ascertain the nature of maritime emergencies attended by UK military (Royal Air Force/Royal Navy) SAR helicopters.

Methods All UK military SAR “medrescues” 1 January 2009–13 March 2010 were entered onto a database. Clinical scenarios were extracted from winchmen's reports. Acuity was estimated using the Manchester Triage Score.

Results

• Of 907 SAR medrescues during the 15.5-month audit period, 172 (19%) were maritime.

• Mean age of casualty 44 years (range 16–87); 90% male.

• Of 130 reports with vessel type noted, 28% of casualties were from fishing boats, 20% military ships; 12% dive boats, 11% passenger ferries/cruise ships and 10% oil rigs. The remainder were on boats ranging from small pleasure craft to oil tankers, plus one surfer.

• The aircraft was able to land on the vessel in 13% of the 168 jobs where this information was recorded, mainly oil-rigs and military ships. The remaining 87% were winched aboard the aircraft.

• 7% of cases were diving-related emergencies; 53% medical/surgical and 40% trauma (including drowning/near-drowning).

• 151/172 cases had sufficient information to enable estimation of Manchester Triage category: 66/151 (44%) were category 1 or 2 and 77/151 (51%) category 3. Only 8/151 (5%) were category 4. None were category 5.

Conclusion Medical emergencies at sea are surprisingly diverse, with a wide variety of major and minor injuries & illnesses. This series ranges from diving emergencies, major trauma, an elderly cruise ship passenger with a ruptured AAA, and obstetric emergencies. Our data are retrospective and the MTS is not designed for prehospital use, but most maritime cases attended by RAF/RN SAR helicopters appear to be genuinely urgent. Lives would be at risk without the service, which features both winching capability & a technician or HPC-registered paramedic on board.