A 65-year-old guest aboard a 58m charter yacht anchored 3 nautical miles off Porto Cervo in August 2026 collapses at 22:40 with chest pain and shortness of breath. The captain reaches MedAire by satellite phone within 90 seconds, the on-call doctor confirms a probable cardiac event by 22:43, the Italian coast guard is contacted at 22:46, a helicopter is dispatched from the Olbia base at 22:52, the helicopter is overhead by 23:18, and the guest is winched off the upper deck at 23:24. The transit to a cardiac unit in Olbia takes 19 minutes. The guest is in a cath lab by 23:55, 75 minutes after collapse. The bill for the helicopter and the hospital stabilisation lands at the guest's personal insurance two weeks later at €34,800.
This is a successful medical evacuation, run by professionals, in a coastal Mediterranean anchorage with fast access to a tertiary cardiac centre. The same incident in the Cyclades in late September would have produced a response time of 90 to 180 minutes. The same incident in a remote Caribbean anchorage in February would have run 4 to 8 hours and cost €120,000 to €200,000. Below is the protocol, the response times by region, the cost bands by transport mode, and the insurance coverage that charter clients should arrange before they board the yacht.
The four-stage protocol
Every commercial charter yacht operates a written emergency medical protocol, signed off by the captain and the chief officer, with the medical chest log and the telemedicine subscription numbers. The protocol runs in four stages.
Stage 1: First assessment (0 to 5 minutes). The first crew member on scene, usually whoever is in service contact with the guest at the time, runs the primary survey (airway, breathing, circulation). The captain is summoned by VHF or pager. The chief stew brings the medical kit. The chief officer or captain arrives within 90 seconds on any normal yacht layout.
Stage 2: Clinical triage (5 to 15 minutes). The captain or chief officer calls MedAire (or the yacht's equivalent telemedicine service) by satellite phone. The MedAire doctor takes a history through the captain, advises on stabilisation, and makes the call on whether to evacuate. Most yachts hold the MedAire subscription, which costs roughly €4,500 to €7,500 a year and includes the helicopter-coordination service.
Stage 3: Coordination (15 to 45 minutes). The captain notifies the relevant coast guard or air-ambulance service. In coastal Mediterranean waters this is usually the national coast guard (MRCC). In remote waters it may be a private medevac operator. The captain prepares the yacht for helicopter operations (clearing the helideck if certified, or marking a winching zone), turns into the wind, and provides position updates every 5 minutes.
Stage 4: Transfer (45 minutes onward). The helicopter arrives, the medical team boards or the guest is winched, and the transit to the receiving hospital begins. The captain logs every detail in the bridge log against MCA reporting requirements. The chief stew prepares the guest's documentation (passport, insurance, medication list) for the family member travelling with the guest.
Response times by region
Response time depends on three things: distance from a coast guard base, weather, and the helicopter inventory available on the day.
Western Mediterranean (Riviera, Corsica, Sardinia). Helicopter on scene typically within 25 to 60 minutes for any anchorage within 30 nautical miles of a major port. Major coast guard bases at Marseille, Nice, Genoa, Olbia, Cagliari, and Palermo. Excellent coverage.
Italian Adriatic and southern Italy. 30 to 75 minutes. Coast guard bases at Bari, Brindisi, Catania, and Naples. Coverage thinner south of Naples in the Eolie. The Italian Air Force occasionally supports civilian medevac with a longer response time.
Greek waters (Cyclades, Dodecanese, Ionian). 45 to 180 minutes. Greek coast guard bases at Athens, Heraklion, Rhodes, and Corfu. Coverage thinner in the central Aegean. The medevac helicopter inventory is limited and busy in high season. A Cyclades anchorage in August on a weekend may face a 90 to 150 minute response.
Croatian Adriatic. 30 to 90 minutes. Croatian coast guard cooperates with the Italian system and has helicopter bases at Split and Dubrovnik. Coverage good along the main charter routes.
Turkish coast. 45 to 120 minutes. Turkish coast guard operates from Bodrum, Marmaris, and Antalya. Coordination with foreign-flag yachts can require additional time for the formalities.
Balearics. 30 to 75 minutes. Spanish coast guard bases at Palma de Mallorca and Ibiza Town.
Caribbean (BVI, USVI, Antigua, St Barths). 45 minutes to 4 hours. The USVI and BVI maintain helicopter coverage from St Thomas. The Lesser Antilles south of St Maarten depend on private operators (RoyalMed, Aero MD) and the response time stretches considerably. A medevac from Bequia or Mustique typically runs 90 to 180 minutes.
Bahamas. 1 to 5 hours. Bahamian coast guard supports civilian medevac with limited helicopter inventory. Most charters in the Exumas plan for a fixed-wing transfer from a nearby airstrip, which adds an hour or more.
Remote Pacific (Fiji, French Polynesia, Galápagos). 4 to 24 hours. Distances are large, helicopter fuel ranges are limiting, and fixed-wing evacuation often requires a multi-leg transit. Charter clients in these waters should brief on the response curve and consider whether a doctor aboard is appropriate.
Cost by transport mode
The cost of a medical evacuation runs through one of three transport channels.
Helicopter (coastal, 30 to 90 minutes' transit). €15,000 to €50,000 for the evacuation itself. The bill includes the helicopter time, the on-board medical team, and the initial stabilisation. The receiving hospital is billed separately.
Fixed-wing air ambulance (regional, 1 to 4 hours' transit). €40,000 to €150,000. Typically used for evacuations from islands without immediate helicopter range or for intercontinental repatriation. The aircraft is a King Air, a Learjet 35, or a Citation, configured as a flying ICU.
Repatriation flight (long-haul, 6 to 24 hours' transit). €80,000 to €350,000. Used when the guest needs ongoing critical care and the family wants the patient repatriated to their home country. Some operators (Medjet, AirMed) sell annual memberships that cover this for a fixed fee.
These are the direct evacuation costs. The hospital bill is separate and depends on the country, the length of stay, and the level of care.
Who pays
The guest's personal medical insurance is the primary payer. Most travel-medical policies cap evacuation cover at €100,000 to €500,000, which is sufficient for any normal coastal evacuation and may not be enough for a long-haul repatriation from the Pacific. Charter clients chartering in remote waters should review the cap in their policy and consider a supplemental evacuation membership (Medjet, AirMed, Global Rescue) for a few hundred euros a year.
The yacht's hull and P&I insurance covers the yacht and its crew. It does not normally cover guest medical evacuation. Some P&I policies extend to charter guests on a goodwill basis, but the cover is not contractual.
The APA does not normally cover medical evacuation. The APA covers operational costs during the charter (fuel, food, docking, pilotage, communications). A medical evacuation is treated as a personal cost to the guest. Some yachts will advance the cost from the APA and bill it back at end of charter, which works if the guest's insurance reimburses on a direct-billing basis. Some will not.
Charter clients should arrive aboard with three things confirmed in writing: their travel-medical evacuation cap, their concierge medical contact (if any), and their next-of-kin authorisation for emergency treatment. The captain's brief includes a check on this. If your captain does not raise it on day one, raise it yourself.
What the yacht does in advance
A well-run charter yacht prepares for medical evacuation before every charter. Three things are done.
Helideck check. Yachts with a certified or touch-and-go helideck verify the helideck is unobstructed and the fuel-safety equipment is functional. Yachts without a helideck identify the upper-deck winching zone and brief the deck crew on clearing it.
Coast-guard plotting. The captain plots the daily cruising route against the nearest coast-guard base for each leg. The expected helicopter response time is logged. Anchorages with response times above 90 minutes are flagged for the family during the welcome brief.
Guest medical brief. The chief stew collects the guest's medication list and any pre-existing conditions during the pre-charter brief. The captain confirms which guests carry EpiPens, inhalers, insulin pens, or anti-coagulants. The medical chest is checked against any guest-specific medication needs.
A yacht that has not done these three things before the charter is a yacht running the medical protocol below standard. The broker should be able to confirm in writing that all three were completed.
What we would change
The yacht industry runs the medical-evacuation protocol better than most charter clients realise. Three things we would still change.
First, the evacuation-insurance question should be confirmed in writing during the contract phase. Most brokers raise it casually. Some do not raise it at all. A charter client who boards a yacht in the Caribbean in February without verified evacuation cover is taking a financial risk that does not need to be taken.
Second, the response-time data by anchorage should be published. Captains know it. Brokers can compile it. The current convention is to discuss it informally during the brief, which leaves the family without the data to compare cruising-ground options.
Third, the long-haul Pacific market needs a clearer concierge framework. The Mediterranean has MedAire, the major coast guards, and three solid air-ambulance operators. The South Pacific has fewer options and the operators are less well-known to brokers. Charter clients in those waters often discover the gap only when they need it.
Frequently asked questions
Who pays for a yacht medical evacuation? The guest's personal medical insurance, sometimes with cost-sharing from the charter's APA. The yacht's hull and P&I insurance does not normally cover guest medical evacuation. Guests should hold travel-medical or specialist evacuation insurance before chartering.
How fast is a yacht medical evacuation? In coastal Mediterranean waters, a helicopter can be on scene within 25 to 60 minutes from the time the captain calls the coast guard. In remote cruising grounds the response can extend to 4 to 8 hours.
Does every charter yacht have a helideck? No. Most yachts under 70m do not have a certified helideck. Many have a touch-and-go pad (sufficient for emergency landings and quick transfers). Yachts without a pad coordinate a winching transfer, where the patient is lifted to the helicopter on a stretcher.
What is MedAire? MedAire is the leading commercial telemedicine and emergency-coordination service for vessels and aircraft. Most charter yachts hold a MedAire subscription. The service provides on-call doctors trained in vessel medicine and coordinates with coast guards globally.
Can the captain refuse to evacuate a guest? Effectively no. If the on-call telemedicine doctor recommends evacuation, the captain initiates the protocol. The captain can override only in extraordinary circumstances (weather closure of helicopter operations, for example), and the override is documented.
What insurance should I have before chartering? A travel-medical policy with at least €250,000 evacuation cover for coastal cruising and €500,000 plus for remote or transoceanic. Consider a specialist evacuation membership for an additional layer.
Related reading
For the upstream question of whether to add a doctor to your charter, see when to bring a doctor on your charter. For other add-on services that sit alongside a medical brief, see yacht security team. For charters with elderly guest parties where the medevac probability is higher, see yacht charter for elderly parties. For the embarkation day brief that includes the medevac protocol, see the embarkation day protocol. For how the bridge officer style affects emergency response, see bridge officer style.
For broader context, the charter pillar lists yachts whose medical readiness we have personally verified. For the financial mechanics, the APA breakdown covers what the charter pays for and what it does not. The Mediterranean charter cost guide gives the wider price context.