Megayachts carry cool toys, and not just helicopters and submarines. There are many devices and services that average boaters may not know about – and one of them is telemedicine.

Telemedicine is a subscription service that gives you access to doctors specializing in areas from orthopedics to endocrinology; medical consultation is available 24 hours a day. No matter what kind of problem you encounter at sea, pick up the phone in your pilothouse, and a voice on the other end of the line gives you step-by-step instructions to follow for splinting a leg, stopping bleeding or treating other maladies.

The services offered by World Clinic, Maritime Medical Access, and MedLink are comprehensive – and they start at prices that might make everyday boaters flinch. Services at World Clinic, for example, start at $8,000 a year for one couple on one boat. That includes 24-hour access to doctors worldwide; a medical locker and onboard pharmacy; medical evacuation insurance, if you're overseas; compilation of your medical records, so you can become a patient in their practice; and a listing of doctors that you can seek out in person, depending on your cruising itinerary.

Summoning assistance from nearby vessels may be the quickest path to help in some situations."These services are great, but they come at a price," said Dr. Michael Jacobs, an internal medicine physician on Martha's Vineyard, co-author of "A Comprehensive Guide to Marine Medicine," and a lifelong boater.If you're planning extended world cruising, telemedicine programs can offer peace of mind, and coordinate your medical care from minor problems to medical emergencies and evacuation. "If you're coastal cruising, there's often a plethora of help all around you, ou just have to make radio contact. A lot of boaters don't realize all of the options that they have."

FINDING HELP

Let's start with the old standby: the VHF radio. Anyone who has ever been part of a cruising community knows that one hail to your fellow boaters indicating even a whiff of a potential problem can result in a barrage of replies and offers of assistance. You just might luck out and get the attention of a doctor sailing a half-mile away, or of an ambulance worker out for a day of fishing who can rendezvous with you in a matter of minutes.

That's not an ideal insurance policy, of course, but your VHF becomes an even more helpful tool for securing emergency assistance if it's a newer DSC-equipped model that is Rescue 21 enabled. If you haven't been keeping up on your marine electronics news, here's what that means: DSC stands for digital selective calling. When that VHF technology is coupled to the U.S. Coast Guard's new Rescue 21 system – and if you take the time to register your unit properly – then you can, at the push of a single button on your VHF radio, send a mayday to the Coast Guard and all boats in the area. The VHF sends your position (if it is integrated with an onboard GPS unit) so that you don't have to, which is a key feature if, say, you're gasping for breath at the time you push the button for help. (Note that Rescue 21 is still coming online along parts of the U.S. coast and is not yet fully operational.)

Handheld VHFs can also be excellent communications tools in a medical emergency. Some have a range that can reach another boat or a U.S. Coast Guard station, depending on where you are at sea. Whether you get help that way or via a more powerful permanentmounted VHF, the handheld will likely be your primary communications tool when rescuers arrive.

Satellite phones are becoming more common. "You cannot be down below in your boat or in your pilothouse, wherever your mounted VHF radio is, and be effectively communicating with a helicopter or a rescue boat," said Jacobs, who spoke at the week-long "Medicine for Mariners and Safety at Sea" conference at The Bitter End Yacht Club on Virgin Gorda in January."You are going to be on deck or in a dinghy. Don't rely on a cell phone for situations like this. You can't dial up the pilot of a Coast Guard helicopter on a direct line. You can't worry about losing your signal while receiving instructions on what to do next. And oh, by the way, cell phones fail when they get wet. You have to imagine that in an emergency situation, the odds of that happening are pretty good."

SATELLITE PHONES

Unlike a cell phone, a satellite phone can be an excellent option for maintaining a signal and communicating during a medical emergency. These, too, are becoming standard equipment onboard offshore cruising boats. "”Satellite phones are not so expensive, but the usage plans vary in price depending on voice and data downloading options. .

If you choose the satellite phone consider having a list of important telephone numbers laminated and affixed near the phone's cradle. To start, you can get the phone number for every U.S. Coast Guard station, along with its area of service. That will tell you where to call for help no matter where you are cruising along the U.S. coast. "You might also take the numbers of your favorite orthopedic surgeon and eye doctor," Jacobs says. "You don't know everything, and you're on a boat, and you may have to deal with serious problems."

Jacobs also urges the use of an EPIRB as a communications device in life threatening medical emergencies. It's obviously a serious act to set off an EPIRB, and you wouldn't want to do so, say, in the case of someone being seasick a half-hour from the dock. But in the case of a true emergency such as a heart attack, when you have no other means of communication, an EPIRB signal that is GPS-enabled will summon help immediately. The rescuers who arrive might not be able to solve your specific medical problem, but they may be in a position to get you to somebody who can. (Note that like VHF radios with DSC and Rescue 21, GPS-enabled EPIRBS must be registered in order to work properly.)

Most important, Jacobs says, is to initiate communications as soon as you have the slightest inkling that something might be wrong. A general alert is better than a mayday, unless you have a truly life-threatening emergency. An early message to all nearby vessels that you might require assistance soon is a lot more likely to help you than a last-minute call after you are frantic from failing to solve a medical problem yourself.

"The time to call is before the water is over the batteries," Jacobs says. "The time to call is before the wind fans the flames. The time to call is when someone with a fracture appears stable. The time to call is when the person is shivering, but conscious and coherent. The time to call is when you want to give an alert about your situation, not just after you have a major problem."