There is "Ask for Help" button, and this one goes to your contacts. 911 goes to emergency center in the USA. Both routes are using some internet protocol if I'm correct, and this is one weak spot (no pun intended). Another one is that this is an indirect way, once you're not in the USA or Canada - or less direct than PLB. I suspect that "human nature" of 911 response centers will cause an additional delay - imagine an operator lady that used to handle local phone calls, and suddenly a signal comes with GPS coordinates in the middle of nowhere, and she has to figure out what to do with this. Contacting appropriate local authorities sounds nice, but how the heck she will do this, speaking English only?
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they won't sell you one with an address or credit card from those places.
Either this, or they have no established procedures of contacting local authorities, except may be a phone number an email for consulate.
Another thing is how good is reception from sea, as you noted. I don't think it makes a difference for a satellite (it's high enough not to be blocked by waves), but what makes difference is the nature of signal - power, frequency and modulation (have no idea how they do it in case of email messages), and also - on the transmitter sensitivity or time to acquire the satellite signal, and on the number of satellites in particular area. As Hugh noted, it's slow to "lock" on satellite (any GPS takes a while, btw, at least 15-20 seconds after you turn it on) - don't know how much slower is SPOT, but this might improve with time.