When most of us think of a medical emergency, we think of the pains, sprains, breaks and aches that a boat can deliver in a pitching sea. But have you ever considered how dangerous a rescue from that sea might be?

Imagine trying to get from your boat into a basket dropped by a rescue helicopter under ideal conditions. Then picture it when you are feeling weak and wet, perhaps even mildly hypothermic. In violent seas. In heavy winds. In the dark.

"You can fall out of a lifeboat and drown," says Dr. Michael Jacobs, an internal medicine physician on Martha's Vineyard, co-author of A Comprehensive Guide to Marine Medicine, and a lifelong boater. "That's probably more serious than a lot of so-called "˜medical emergencies.'"

You should call for a medical evacuation only if the crewman is critically ill, as in the case of a heart attack, or the condition requires urgent medical attention beyond your capabilities on the boat, such as multiple traumatic injuries, Jacobs says.

Helicopter rescue is not something most of us can practice. Listen to instructions carefully."Evacuations are serious business," he explains. "There's risk to the patient, rescuers, crew and to your boat."

What makes medical evacuations so challenging is that they involve many activities you cannot practice. How many times have you tried to listen to instructions on a radio while your wife bleeds profusely and your boat pitches in gale-force winds? Have you ever practiced getting into a basket dropped out of a helicopter while you are writhing in pain from a freshly broken wrist? Have you ever talked a container ship captain into letting you practice working with his crew to retrieve you in one of his lifeboats?

Of course you haven't. Few people have. Should you find yourself with a medical emergency that requires evacuation, things are going to happen quickly and in ways you have not experienced or even imagined. There will likely be multiple problems to deal with simultaneously – and you may be trained for precisely zero of them.

In such situations, the two best things you can have on your side are a written plan for your cruising companion or crew to follow, and good listening skills.

LISTENING FIRST

The first course of action is usually hailing the Coast Guard on your VHF radio, using channel 16. Assign a crewmember to monitor the radio from the time you make the call until the rescue is complete. This is perhaps the most serious job on the boat in a medical emergency: listening and relaying instructions.

"The Coast Guard will tell you what they're going to do and when they're coming," says 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. "They will tell you what course to take and what you need to do before they get there. If they tell you not to activate your EPIRB, then don't activate your EPIRB, even if all your instincts as a boater tell you it's the right thing to do. You are not in charge."

The Rescue Coordination Center or local Coast Guard station may deploy a helicopter, rescue boat, or nearby commercial ship depending on your location, local weather, availability of crew and equipment and nature of the medical emergency. Don't expect an HH-60 Jayhawk helicopter every time.

Often, the Coast Guard will send nearby vessels to assist you.If a helicopter is sent, secure all the loose items on deck. Lower and secure all sails, remove any poles or equipment that may snag the wire that the helicopter will use to lower a rescue basket, and make sure everyone is wearing a PFD (as well as a survival suit, if conditions warrant that). Unless the Coast Guard instructs otherwise, shift your course so that the wind is 45 degrees off your port bow. This is because the helicopter will likely approach your boat on the port stern quarter, giving the pilot optimal visibility from his cockpit seat. Never shine a light or strobe directly toward the helicopter, and never fire flares toward the helicopter. You'll blind the captain and, potentially, damage the very craft that is there to assist you.

Next, wait for the rescuers to tell you what to do, and then do it. You will feel a strong adrenaline rush plus heavy winds and deafening noise as the helicopter makes its approach. Try to concentrate. Listening is the best life-saving skill you may have at this time.

FOLLOW INSTRUCTIONS

In fact, failing to follow instructions during a medical evacuation can make your situation far worse. Imagine you have been thrown from your boat, have broken a few ribs and are beginning to shiver from cold in the water. A rescue helicopter arrives overhead and sends a basket down a line to retrieve you. A rescue diver is in the water nearby, and he tells you to grab the line attached to the basket. You hear him, but as soon as the basket itself is within reach, you instinctively reach out and grab it.

"If you grab that basket, you're going to get a static electricity shock," Jacobs says. "It comes from the act of lowering the basket with a metal cable from the helicopter. The shock won't defibrillate you, but it will be uncomfortable and add to any existing problems that you have. Wait for the basket to hit the water before touching it. Grab the rescue line instead."

Now, imagine that as you finally get safely into the basket, your wife is watching from your boat with great relief. She wants to make sure that you really are secure – so she ties a line from the rescue basket to the boat, just in case things go wrong from the helicopter's end.

"If you secure anything from the basket to your boat, even a single hook, the Coast Guard will sever the line from the helicopter to the basket," Jacobs explains. "They may give you one more chance, but just don't do it. Don't try to hang onto your boat and get into the basket at the same time. Do what you're told. Get into the basket the way that you're told. You're going to be tired and frightened. You're in no position to be making decisions."

That includes the decision about what to do with your boat following a medical evacuation. In some rescue situations – say, if you are single-handed and offshore – the very act of your being medically evacuated will require you to scuttle your boat. It might be a brand-new Swan or Sea Ray worth a million of your hard-earned dollars, and it may have to be sunk. The Coast Guard cannot allow an unattended craft to become dangerous flotsam and cause an emergency for an unsuspecting vessel that is traveling in your direction.

The thought of losing your boat may be more serious to you than whatever discomfort you are feeling when you first call for a medical evacuation. Help is there if you need it, but once you call, remember that you will have to accept it on other people's terms.