RedactedNarrative: The operator was not anchored and the boat was not turned on.  He was attempting to get the motor down and couldn't.  So, he threw his ladder overboard and started to climb down to troubleshoot the motor mechanics from the water.  The rung on the ladder broke.  He fell and impaled the inside of his right forearm just below the elbow on a cleat.  
  
  The RN at the hospital asked him if he brought the skin with him.  His arm guts were hanging out.  They said the gap was too huge to pull closed and they would need to speak with a plastic surgeon.  I will follow up in a few days.