Case Study: Motion Sickness on a Surf and Dive Trip in Oahu, Hawaii

The Setting

You’re leading a small group on a combined surf and introductory scuba trip on Oahu. The group is staying on the North Shore and driving early in the morning to a south shore harbor to meet the dive boat. The coastal road is narrow, hilly, and full of tight curves. Several group members mention feeling a little queasy during the drive, but one participant, a 27-year-old female named Maya, becomes noticeably nauseated and pale in the back seat.

When you arrive at the harbor and step out of the vehicle, Maya reports that her nausea improves significantly within about 10 minutes. She drinks some water, eats a few crackers, and feels stable enough to proceed.

Once aboard the dive boat and underway in moderate swell, Maya’s nausea quickly returns and intensifies. You are one of the trip leaders and hold a Wilderness First Responder (WFR) certification. You decide to formally assess Maya and begin symptom management.

SOAP Report

Subjective

The patient is a 27-year-old female whose chief complaint is nausea and vomiting associated with motion. Symptoms began during a winding car ride and improved briefly when stationary on land, then returned and worsened once on the boat. She reports dizziness, nausea, and stomach discomfort. She denies abdominal pain, headache, fever, diarrhea, or recent illness.

The patient is alert and oriented and able to communicate clearly.

Objective

Patient Exam:
The patient is seated on deck, pale and mildly diaphoretic. She appears uncomfortable but not distressed. No signs of trauma. Her abdomen is soft and non-tender. No focal neurological deficits. She has vomited twice since leaving the harbor. Able to ambulate with assistance.

Vital Signs

TIME	09:10
LOR	A+Ox4
HR	80, strong, regular
RR	18, regular, easy
SCTM	Pale, cool, sweaty
B.P.	radial pulse present
Pupils	PERRL
T°	Not taken

History

Symptoms:	Nausea, dizziness, repeated vomiting, mild fatigue. Symptoms clearly correlated with motion exposure.
Allergies:	No known allergies.
Medications:	Denies any medications, prescription or over-the-counter.
Pertinent Hx:	Patient reports a history of mild motion sickness as a child but states she usually tolerates boats reasonably well.
Last in/out:	Light breakfast approximately two hours prior with a coffee. Small amount of water consumed this morning. Vomited twice since boarding the boat. Urinated prior to departure. No diarrhea.
Events:	Symptoms started during the curvy drive, resolved temporarily at the dock, then returned and worsened once underway in moderate ocean swell.

What is your Assessment and Plan? Think about this before moving to the next page.

Assessment

• Likely motion sickness triggered by vehicle travel and boat movement.
• Dehydration risk due to vomiting.
• Possible contributing factors include early morning travel, light food intake, and ocean swell.
• Secondary differential includes gastrointestinal illness or hormonal causes such as early pregnancy, though no additional symptoms currently suggest these as primary causes.

Plan

• Moved patient to the most stable area of the boat with visual access to the horizon.
• Encouraged fresh air exposure and minimized visual fixation on close objects.
• Provided ginger chews and ginger tea.
• Applied pressure point stimulation to inside of the wrist (P6/Neiguan).
• Encouraged small sips of water as tolerated.
• Monitored mental status, hydration status, and frequency of vomiting.
• After continued vomiting despite interventions and increasing fatigue, recommended discontinuing the dive portion of the activity.
• Coordinated return to shore with the group leader.
• Planned a modified activity schedule for the following day to reduce motion exposure.

Anticipated Problems: 

• Dehydration and electrolyte imbalance
• Worsening nausea impacting safety on the water
• Reduced participation affecting group logistics
• Potential underlying illness if symptoms persist off the water

What Happened?

Despite ginger, pressure point stimulation, fresh air, discontinuing reading on her phone, and horizon positioning, Maya continued to vomit several more times during the boat ride. She became increasingly fatigued and uncomfortable. The leadership team made the decision for her to remain on shore the following day rather than return to the boat.

The group divided activities: several participants went diving as planned, while Maya joined a smaller group surfing near shore, which allowed better control over motion exposure and an easier exit if symptoms returned. Maya tolerated surfing well and reported minimal nausea once back on land.

By the following day, she felt significantly better with no further vomiting. She planned to consider motion sickness medication for future boat activities and follow up with her primary care provider if symptoms returned or persisted.

Comments

Motion sickness is a common issue in wilderness and adventure settings and can escalate quickly from discomfort to operational and safety concerns. Early recognition, environmental modification, and simple interventions like ginger, pressure point stimulation, horizon positioning, and airflow can often improve symptoms; however, not all cases respond adequately.

Monitoring trends, hydration status, and functional capacity helps guide decisions about whether a participant can safely continue an activity. Modifying objectives and splitting groups when appropriate can allow trips to continue safely while supporting individual needs.

Considering alternate causes of nausea such as gastrointestinal illness, dehydration, heat illness, medication effects, or pregnancy is part of a thorough assessment, especially when symptoms persist outside of motion exposure or fail to improve as expected.

Having a trusted reference available in the field can help reinforce assessment pathways and treatment strategies when decision-making pressure is high. Carrying resources like the NOLS Wilderness Medicine Field Guide allows you to quickly review motion illness management, red flags, and evacuation thresholds when you’re far from definitive care.