On a recent medical training course onboard a large motor yacht, the chef shared a story that highlights the importance of being trained for the worst case scenario. 

While working in the owner’s villa, he was using a traditional wood-burning oven. As he reached inside to remove a dish, his forearm brushed against the interior wall. Instinctively he pulled back, but the damage was already done and he described how the skin on his arm began to peel away almost immediately.

What he had sustained was a deep, severe burn—likely full thickness in areas.

He described not knowing what to do. There was no immediate cooling and no structured response, meaning the pain escalated rapidly, and the injury continued to worsen in those critical early minutes.

Sadly this story ended in a prolonged recovery, lasting scarring, and permanent slight restriction of movement in his arm. 

He said to me something I hear far too often onboard: “I wish I had done this course before it happened.”

This story reminded me that burns can be both life-changing and potentially career-changing injuries, and crew need to be prepared to treat a burn right at the time of injury. 

Burns are one of the most common injuries encountered onboard yachts. From galley accidents to engine room and laundry room hazards, electrical faults to rope burns, the risk is ever-present in a high-paced, high-performance confined environment where heat, fuel, chemicals, and hot equipment are managed daily. 

Effective burn management onboard is not about advanced medicine—it is about immediate, simple, and correct first response. The actions taken in the first 10–20 minutes can dramatically influence pain, tissue damage, infection risk, and long-term outcomes.

This article outlines how burns happen onboard, how to respond effectively, and when escalation or evacuation is required.

According to data from the MSOS TMAS service, common burns onboard yachts typically fall into several categories:

Thermal burns (most common)

• Hot liquids (coffee, boiling water, oils)
• Steam from galley equipment and irons in laundry room
• Hot surfaces (engine parts, exhausts, galley equipment, laundry)
• Open flames or flare-ups in the galley

Friction burns

• Rope burns during line handling
• Winch or capstan incidents
• High-speed deck operations under load

Electrical burns

• Faulty wiring or exposed circuits
• Contact with live systems
• Lightning-related injuries (rare but severe)

Chemical burns

• Cleaning agents
• Fuel or battery acid exposure

Cryogenic burns 

• Dry ice in the galley or provisioning
• Contact with extremely cold substances causes tissue freezing

ONBOARD BURN EMERGENCY RESPONSE PLAN 

A simple, structured approach helps crew act quickly and effectively, remember the BURNS acronym – 

Break the burn

Stop the burning process immediately

Before you do anything else, make sure you’re not putting yourself at risk — turn off the heat source, kill the power, or get the person away from whatever caused the burn.

Under cool water  (CRITICAL STEP)

Begin cooling as soon as possible

Use cool (not freezing cold) running water for 20 minutes and no less. 

Remove constricting items

Rings, watches, tight clothing (before swelling occurs)

Non stick dressing 

Use a clean, non-adhesive dressing such as a burn dressing, inside dressing or cling film

Severity – estimate size and depth

Estimate size and depth

Remember a Secondary Survey – Check for airway involvement or associated injuries

Finally, always seek medical advice from MSOS TMAS even if the burn looks minor for assessment and pain relief, and take vital signs and complete an ATMIST report form for more severe burns. 

WHY COOLING WITH RUNNING WATER FOR 20 MINUTES IS SO IMPORTANT 

Cooling is the single most important intervention in burn care. It seems like a simple treatment, but has been shown by studies conducted by The Burns Society of the UK and other leading research bodies that the skin is an amazing thermal retainer of heat and cooling for twenty minutes does the following 

• Stops ongoing thermal damage (burns continue to “cook” tissue after the heat source is removed, body tissue often remains at 40-60 degrees long after the hot item is removed.
• Reduces pain significantly
• Minimises swelling and inflammation, reducing delayed shock from fluid loss from the burnt body tissue
• Improves healing outcomes and reduces scarring.

Cooling best practice

• Ensure water is cool, not cold (avoid ice or iced water)
• Avoid hypothermia – only cool the burn area, keep the body warm with towels and blankets
• Use galley sink sprayer for hands/arms
• Shower for larger burns
• Use tap water, shower, or hose
• Use eye wash bottles for initial cooling if no running water source available
• Do not spray water directly onto the burn area if possible spray above to run through burn to avoid damaging tissues and causing pain.

DO NOT USE 

• Ice (causes vasoconstriction and tissue damage)
• Oils, butter, toothpaste or eggs (I have heard every old wives tale on courses over the years!)
• Burns dressings or adhesive dressings or burn creams to cool, they are the secondary response

AFTER COOLING COVER TO PREVENT INFECTION, THE SECOND BIGGEST CONCERN WITH BURNS ONBOARD 

Covering the burn after cooling is vital as it reduces pain by protecting exposed nerve endings, prevents contamination causing infection (burn tissue is very prone to severe infection), and helps retain moisture for healing. 

Cling film (plastic wrap) is an excellent burn cover and included in the MSOS Medical Kits

Lay loosely over the burn, do not wrap tightly as the burn area may swell, affecting circulation to a limb.

Cling film advantages – 

• Sterile (when first unrolled)
• Non-adherent
• Retains moisture – we don’t want burns drying out too quickly
• Transparent for monitoring
• Malleable – can be shaped to the injury

Alternative dressing options

• Burn dressings or iodine dressings from medical kits
• Wet gauze if nothing else available

Estimating severity with burn size and depth

Understanding burn size helps determine severity and need for evacuation.

Rule of palm

The patient’s palm (must be patients palm to account for body size) equals 1% of body surface area (BSA)

This is the most practical method onboard.

General guide

Small burn: <5% BSA

Moderate burn: 5–15% BSA

Severe burn: >15% BSA (adult)

Assessing burn depth

Superficial (first degree)

Red, dry, painful

No blisters

Example: mild sunburn

Partial thickness (second degree)

Blisters

Wet, red, very painful

Most common onboard

Full thickness (third degree)

White, charred, or leathery

May be painless (nerve damage)

Always serious

When does a burn require evacuation?

Evacuation decisions should always involve TMAS, but key triggers include:

• Airway burns (smoke inhalation, facial burns) 
• Electrical burns
• Full thickness burns
• Burns >10–15% BSA
• Burns involving:
• Face
• Hands
• Feet
• Genitals
• Major joints
• Any uncertainty about depth
• Signs of infection – casualty feels unwell or gets a fever (temp above 38 degrees), or burn area starts leaking fluid or has an odour.  
• Severe pain not controlled with basic analgesia

Unique burns onboard 

Rope burns

Characteristics

Combination of friction and heat, consider a thermal burn

Often deep despite small surface appearance

Can restrict limb movement if not treated effectively and prevent deck work. 

Management

Cool thoroughly (often overlooked) and cover 

Carefully assess depth—these can be deceptive

Rope burns often need closer monitoring due to deeper tissue damage.

Cryogenic burns (dry ice in the galley)

Dry ice (solid CO₂) can cause severe cold burns. These are often underestimated but can cause deep tissue injury.

Characteristics 

Freezes tissue rapidly, similar to frostbite

Management

Avoid rubbing the area to remove particles 

Do NOT use hot water

Rewarm with cool to lukewarm water (not >37°C)

Protect and cover as per burn protocol

Electrical burns

Electrical injuries are particularly dangerous.

Why they’re serious

Damage occurs internally along current pathways

Small external burns can hide severe internal injury

Risk of cardiac arrhythmias or cardiac arrest in the minutes or hours after the exposure

Management priorities

Ensure power is OFF before touching casualty

If casualty looks unconscious follow DRABC approach (Danger, Response, Airway, Breathing, Circulation)

If casualty is conscious take vital signs and perform secondary survey to assess for 

– Cardiac issues

– Muscle damage

– Entry and exit wounds

Always contact MSOS TMAS for evacuation even if external damage looks minimal. 

The bigger picture: preparedness onboard

Effective burn management is part of the golden triangle of yacht medical care:

Well-stocked medical kits for your itinerary

Pre-Season Training and regular drills for confident crew response 

Access to TMAS support

Crew who are trained, calm, and decisive can dramatically improve outcomes in what is often a high-stress, fast-moving situation. Ensure you get pre-season medical training by a qualified MSOS professional yacht medical trainer, and run regular drills based on your training weekly/monthly, if you don’t use it you lose it! 

Contact MSOS for support worldwide with your medical system onboard.

Sara Grace Butler
DTN RN Bsc, Expert Yacht
Medical Trainer, MSOS
sally@msos.org.uk
www.msos.org.uk