No surprize - running a small boat offshore can be hazardous. But three things - advancements in electronics, more reliable outboard motors, and the advent of of marine towing services - have made the risks more acceptable. Add in a heavy dose of caution, common sense, and time on the water, and you're about as well prepared as you can hope to be...

• Stuff bolted to rails tend to rotate around the rail when put under stress. Rail-mounted rodholders look like handholds when you're going overboard, so they need to be as sturdy as handholds. We've nearly gone over a couple of times when we grabbed a rod holder for support and it turned around the rail it was mounted to, allowing our hand to slip off.
  
  
• Gear needs to be stowed so that you don't trip over it.
  
  
• HIgh railing around the boat perimeter is a good idea, but interferes with fishing. On Toy Boat 2 we have high bow and side rails, but none in the stern.

Let's start with the case where the engine is running when the accident occurs. Hopefully, you remembered to attach the engine's kill switch to you, so the engine stopped when you fell out. If not, you may never see the boat again, especially if you have no-feedback or hydraulic steering, or an autopilot. In years past, with rotary steering, the engine's torque sometimes would cause the boat to make a big circle, and allow you to try to catch it as it circled back. This was a mixed blessing because there have also been cases where people were run down by their own boat.

Even if the motor is not running at the time you go over, you may still have problems catching the boat. If the wind's blowing 20 MPH and you go over the side, will you be able to swim fast enough to catch the boat as it drifts away? Skiffs with high freeboard catch a lot of wind, and because of their shallow draft, can sail away pretty quickly.   

Sailors have known about this issue for a long time, and have developed specialized teathers to keep them connected to the boat if they go overboard. These tethers are basically long sections of nylon webbing that have rubber shock cord inside, and carabiners, snap hooks, or shackles on either end. One end goes on the sailor (who is usually wearing a specialized harness or harness/lifevest combination), the other end goes to a rail or a safety line (called a "jackline") running the length of the hull. The shock cord is there to contract the tubular webbing and keep it under control as the boater moves around the boat.

In Toy Boat 2, we keep two home-made tethers handy. Clipped to the console handrail, they are long enough to let us walk to the far corners of the rear cockpit without unhooking. We built ours from left-over stuff from our rock-climbing days: 1" tubular nylon webbing, two carabiners, and some light rubber shock cord. Since we wear SOSpenders life vests all the time while on the water, we clip the other end to the vest's harness.

If you use tethers, it is important to make sure you use the motor's dead-man switch. If you go overboard while wearing a tether, you don't want the the motor to keep running...

Here's a neat trick to get back in, which we heard in a seminar given by Don Iovino, a well-known Southern California bass pro: If your engine has an external trim-and-tilt switch, swim to the back of the motor, and stand on the anti-ventilation plate, one foot on each side of the lower unit. Reach around to the T-and-T switch, and tilt the engine up. The hydraulics are strong enough to lift you and the motor out of the water, making for a relatively easy re-entry into the boat. 

• Staying afloat until help arrives:
  The vast majority of fatalities in boating come from people drowning because they weren't wearing some sort of personal floation device (PFD). It doesn't matter if you're a strong swimmer or not - you can hit your head going over the side, or you can succumb to hypothermia if you are in the water long enough.
  
  We lost a good friend many years ago on the Colorado River when he (apparently) slipped in his boat, and hit his head as he went over the side. He was not wearing a PFD. They found his body wedged under a log in a bend in the river the next day. As the Search-and-Rescue team leader told us: "It's a common misconception that people float when they drown. Actually, they sink and go right to the bottom. The body doesn't float until it's been in the water long enough to decompose."  Now there's a pleasant thought...
  
  The right kind of PFD will keep you face-up, even if you are unconscious. If you get knocked out as you go over, but are wearing a PFD and a tether, you might be out for a while, but hopefully you will come to within reach of the boat.
  
  Standard foam life vests are typically bulky and uncomfortable, so they wind up in a storage compartment somewhere. We chose to go with SOSpender automatic inflatable vests instead because they are comfortable and unobtrusive, even when fly-fishing, and they have USCG Type II performance.
  
  Note that we said "USCG Type II performance", not "USCG Type II". That is because these vests are classified as a USCG Type V PFD. Type I and II PFDs do not have to be worn to count in the safety equipment inventory for a boat. Type V PFDs have to be used in accordance to the manufacturer's instructions in order for it to be counted as part of the required safety gear.
  
  In the case of the SOSpenders model that we purchased, the vest must be worn at all times in order for it to count. There are some types of inflatable PFDs that
  
  Courtesy Mustang Survival
  are classified as standard Type I or Type II vests, and these do not have to be worn to be counted as part of the boat's safety equipment. But to us, that's counter-intuitive. The whole point of buying an inflatable PFD is so that you will wear it all the time .
  
  An exciting recent development is the Mustang LIFT inflatable vest. This lifevest is designed to hold the user's head up to 9" above the water surface, reducing the number and severity of mouth immersions, even in rough water. Why is this important? Even if you are floating face-up in a life vest, it is still possible to drown. Many Type I and II vests do not support the user's face very high above the water, and in rough weather, the user can still drown from repeated face dunkings, especially if unconscious . So even though it is "only" rated for Type III performance, in actual on-the-water tests, the LIFT system does as well or better than a USCG Type I offshore vest in protecting the wearer.
  
  
• Making sure you can be found:
  
  
  Courtesy ACR
  Electronics
  If you go overboard in the dark, will anyone be able to find you without running you over? We typically have both a chemical lightstick and a whistle on every vest. The lightstick is replaced annually, when we service the SOSpender's arming mechanism. A better solution would be the use of a personal strobe, such as the ACR Firefly Waterbug, but these are fairly expensive, at an open market price of roughly $90.00 for a water-activated model.
  
  
  Courtesy McMurdo
  Pains-Wessex
  
  Another very useful device is the Personal Locator Beacon (PLB). A PLB is a small transmitter that communicates with the same low-earth-orbit satellite network used by marine EPRIBs and aircraft ELTs. By triangulating transmission positions between multiple satellites, it is possible for rescuers to get within a few miles of a PLB. Some PLBs also have provisions for being hooked up to an external GPS, or have an embedded GPS unit, and these allow rescuers to get much closer.
  
  Until a few years ago, this type of technology required a transmitter roughly the size of a coffe can. Now, it is possible to buy PLBs that are about the size of a pack of cigarettes. PLBs this size can be attached to a life vest. They are pricey (in the $550+ range open market), so they're not for everyone. For more information, check out the "Equipped to Survive" website, which has a great article and FAQ page on PLBs.  Leaders in this field are ACR Electronics and McMurdo Pains-Wessex.
  
  Note that these are not replacements for personal strobes or light-sticks, they are ment to allow you to be located by the Coast Guard, not by your buddy in the boat.
  
  
• Staying healthy until help arrives:
  The main issue with staying in the water too long is hypothermia. Even in moderately warm water, you can quickly lose enough body heat to perish, so your priority should be to get out of the water as quickly as possible, and get dry and warm.
  
  If it looks like you are going to be in the water a while, there are a number of things you can do to conserve body heat. Givens Marine Survival Company has a good page which describes what you can do to survive prolonged immersion in cold water, including the H.E.L.P. position. You should review and practice the techniques described.
  
  Courtesy
  Mustang
  Survival
  
  
  If you operate on a regular basis in rough, cold water, you might consider buying a flotation suit or an immersion suit , such as those made by Mustang Survival or Viking. Flotation suits are one-piece jumpsuits that have floatation / insulation built-in. They help stave off hypothermia in moderately cold water, and also act as PFDs. Immersion suits are similar in concept, but are built like diving dry suits and work in much colder water.
  
  Both options are expensive (flotation suits cost in the $350 - 500.00 range, immersion suits, $550 - 1,500), and have the disadvantage that you have to have enough foresight to put them on before you get in trouble. But if you fish regularily in cold rough water, they make sense. Both can be worn like regular outer garments, but are obviously very warm, and may not be appropriate for your environment.