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Highly skilled NSRI volunteers perform the majority of medical evacuations at sea in South Africa. Medevac veteran Ian Gray tells us why this work is so risky.

On 9 October, a Sunday afternoon, NSRI Gqeberha duty crew responded to a call from a bulk carrier 18 nautical miles off-shore, to evacuate a sailor who was experiencing a medical emergency. NSRI sea rescue craft Spirit of Toft was launched, accompanied by Eastern Cape Government Health EMS paramedics, to assist.

On arrival at the vessel, an EMS paramedic and two NSRI rescue swimmers boarded the vessel and took the 65-year-old Pakistani male into their care.

“Medevacs are one of the most dangerous types of rescue the NSRI does,” says Ian Gray, Regional Representative for Region 4 (which includes stations at Storms River, Oyster Bay, St Francis Bay, Jeffreys Bay, Gqeberha, Port Alfred, East London and Kei Mouth) and former commander of Station 6 (Gqeberha).

“Large cargo ships are like moving mountains: it takes incredible skill to manoeuvre a comparatively miniscule rescue craft around one without being crushed. To pull up alongside, and to lower an incapacitated person – who may be on oxygen or in a fragile state – down the side of the vessel in a stable manner, requires strong high-angle rescue skills. There are a lot of moving parts to the operation. Many of our medevacs occur at night, with poor visibility, and we may encounter language barriers with international crews, on whom we have to rely for assistance. In past years, when piracy was more common, many ships had barbed wire along their hulls to repel attacks, which we then had to navigate in medevac situations.”

The rescue of the Pakistani sailor – who was in critical condition – involved manoeuvring the patient in a stretcher down four flights of steep, narrow stairs, which took over an hour just to get to deck level. The rescue team then had to employ high-angle rescue techniques (ropes, pulleys, etc) to transfer him to the NSRI rescue craft, and into the care of the EMS paramedics.


While the South African Air Force (SAAF) does conduct medevacs that require airlifting, the vast majority of medical evacuations that occur at sea are conducted by NSRI volunteers, who are called in when a sick or injured passenger or crew member cannot disembark unaided – in other words, if their mobility is impaired. This could be anything from a broken finger (which would compromise a person’s ability to climb down a ladder), to concussion from a fall, stroke, illness and so on.

“We conduct roughly 50 medevacs annually,” says Ian, “so that’s almost one a week. During the pandemic, it was closer to 70. Gqeberha’s port is situated such that it is the most accessible for the busy international shipping lane along the South Coast. Gqeberha station performs about 50% of the large-vessel medevacs in South Africa.”

The NSRI has been regularly conducting large-vessel medevacs since the ‘70s; however, it was only in the late ‘90s – when shipping along our coasts became a lot busier due to the lifting of sanctions – that a manual was developed and training was standardised into a three-tiered programme.

Ian has been with the NSRI and Gqerberha station for over 40 years, and has led so many medevacs that he’s probably forgotten more than most volunteers have participated in.

Currently, he says, there is a dire need for more helicopters to assist with medevacs. While SAAF helicopters and other commercial operators do work with the NSRI under the coordination of the Maritime Rescue Coordination Centre; they do not always have the capacity to assist.

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